In 12 the vessel was constricted by scar tissue and in nine it was trapped within the fracture. The brachial artery was explored at this time in 21 children. The authors of two papers 3, 4 in this issue of the Journal consider this question further.īlakey et al 3 describe the outcome in 26 children referred to their institution at a mean of three months after fracture.
Supracondylar fracture humerus how to#
The question remains as to how to proceed if, after satisfactory reduction, the radial pulse does not return although the hand is warm and well-perfused, the so-called ‘pink, pulseless hand’. If the circulation is not then restored and the hand remains poorly perfused, vascular exploration and possible repair by an appropriate specialist are necessary. Arterial spasm may improve after retrieval of the artery from the fracture. If reduction and fixation are achieved, but the hand remains poorly perfused, anterior exploration of the fracture and artery is indicated. Incarceration of the brachial artery should be suspected if there is a block to reduction, and open reduction and retrieval of the anterior cubital structures from the site of the fracture are indicated. This is not an emergency provided that the hand is well perfused, but a pulseless, poorly perfused, mottled hand requires urgent reduction and fixation of the fracture. Extension supracondylar fractures of the humerus are the most common fractures involving the elbow in children and the literature reports approximately a 10% to 20% incidence 1 of an absent radial pulse in children presenting with a Gartland 2 type III fracture.
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