Management of Pulseless Pink Hand in Pediatric Supracondylar Fractures of Humerus

Sabharwal, Sanjeev; Tredwell, Stephen J.; Beauchamp, Richard; Mackenzie, William G.; Jakubec, D M; Cairns, Robyn; LeBlanc, Jacques G.

doi:10.1097/01241398-199705000-00007

Cited by 97 publications

(72 citation statements)

References 18 publications

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“…Sabharwal et al [21] supported the view that the combination of segmental pressure monitoring, colourflow duplex ultrasound and magnetic resonance angiography are sufficient evaluation tools for the patency of the brachial artery. On the contrary, some authors believe that these techniques do not have the specificity and sensitivity of angiography [23].…”

Section: Discussionmentioning

confidence: 64%

“…Observation is the treatment of choice for many authors [10,16,21]. If the hand remains pulseless but well perfused after stabilisation, they suggest that the vascular injury should not be treated and instead rely on collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

“…According to the same authors, the rich collateral circulation around the elbow is sufficient for the viability of the arm, whereas early revascularisation procedures are associated with a high rate of asymptomatic reocclusion and residual stenosis of the brachial artery [21]. However, the possibility of limb length discrepancy [21,24], claudication [18,24], cold intolerance [17] and thrombus migration [1] should be considered if this method of treatment is selected. Moreover, there are no series available with long follow-up and a significant number of cases to support the superiority of a treatment option that finally leads to an arm that relies only on collateral circulation.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of pink pulseless hand following supracondylar fractures of the humerus in children

Korompilias

Lykissas

Mitsionis

et al. 2008

International Orthopaedics (SICO

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Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction.Résumé Au cours d'une fracture supra condylienne du coude déplacée, les complications vasculaires sont relativement fréquentes. Le traitement, lui aussi, est largement controversé, notamment lorsqu'il existe une absence de pouls radial après la fracture. Entre 1994 et 2006, 66 enfants présentant une fracture supra condylienne du coude ont été traités. 5 présentaient une complication vasculaire avec absence de pouls radial. Chez un des patients, le pouls radial est réapparu après réduction à foyer fermé. Chez les 4 autres patients, il a été nécessaire de faire une réduction sanglante avec exploration vasculaire. 3 des patients avaient une occlusion de l'artère humérale. La thrombectomie a été réalisée avec restauration du pouls radial. Sur un patient, il s'agissait d'une contusion de l'artère brachiale avec spasme et une réapparition du pouls après endar térectomie. L'exploration vasculaire chirurgicale doit être réalisée même si la main se recolore après une réduction à foyer fermé.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of pink pulseless hand following supracondylar fractures of the humerus in children

Korompilias

Lykissas

Mitsionis

et al. 2008

International Orthopaedics (SICO

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“…Sabharwal et al 17 supported the view that the combination of seg mental pressure monitoring , c olour! ow duplex ultrasound and magnetic resonance angiography are suf•c ient ev aluation tools for the patenc y of the b rac hial artery .…”

supporting

confidence: 50%

Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis

Shrestha

Das

Rayamajhi

et al. 2013

Journal of Institute of Medicine

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“…There is still no consensus on which supracondylar humerus fractures can be treated in a delayed fashion, and delayed treatment may increase the need for an open reduction [6,7]. The ''pulseless'' supracondylar fracture remains an emergency [8,9]. The second recent trend is that divergent lateral pinning has replaced cross pinning, reducing ulnar nerve injuries [10].…”

Section: Introductionmentioning

confidence: 99%

Pediatric supracondylar humerus fractures: Treatment by type of orthopedic surgeon

Farley

Patel

Craig

et al. 2008

Journal of Children's Orthopaedics

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Purpose Outcomes in children with supracondylar humerus fractures were stratified by type of treating orthopedic surgeon: pediatric orthopedic surgeon and nonpediatric orthopedic surgeon. Methods The outcome factors in 444 children examined included: open reduction rate, complications, postoperative nerve injury, repinning rate, need for physical therapy, and residual nerve palsy at final follow-up. Results For the severe fractures, significantly more fractures were treated by open reduction in the pediatric orthopedic surgeon group than in the nonpediatric orthopedic surgeon group. There were no other significant differences in outcomes between the fractures treated by the pediatric orthopedic surgeons and nonpediatric orthopedic surgeons. Conclusions This study supports the assertion that both pediatric and nonpediatric orthopedic surgeons in an academic setting have sufficient training, skill, and experience to treat these common injuries.

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Management of Pulseless Pink Hand in Pediatric Supracondylar Fractures of Humerus

Cited by 97 publications

References 18 publications

Treatment of pink pulseless hand following supracondylar fractures of the humerus in children

Treatment of pink pulseless hand following supracondylar fractures of the humerus in children

Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis

Pediatric supracondylar humerus fractures: Treatment by type of orthopedic surgeon

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