Management of the Pediatric Pulseless Supracondylar Humeral Fracture: A Systematic Review and Comparison Study of “Watchful Expectancy Strategy” Versus Surgical Exploration of the Brachial Artery

Delniotis, Ioannis; Delniotis, Alexandros; Saloupis, Panagiotis; Gavriilidou, Alexia; Galanis, Nikiforos; Kyriakou, Aikaterina; Potoupnis, Michail; Tsiridis, Eleftherios; Ktenidis, Kiriakos

doi:10.1016/j.avsg.2018.05.045

Cited by 18 publications

(23 citation statements)

References 37 publications

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“…In a PPH, the traditional strategy of close observation should not be revisited as long as there are no signs of deterioration of the vascular status. 11 The present study has some limitations which should be acknowledged, including the retrospective analysis of data, lack of su cient cases, and lack of results of nal and intra-operative CFDU. Future studies are warranted involving larger cohorts recruited from multiple centers, and the development of an animal model would be bene cial to study the collateral circulation of the elbow and long-term effects of ligation of the brachial artery on limb function and development.…”

Section: Discussionmentioning

confidence: 87%

“…The decision of whether to undertake surgical exploration for SHFs is a subject of some debate presenting with a PPH. [10][11] Some clinicians recommend aggressive exploration and vascular reconstruction 3, 8-10, 12-14 while others recommend close observation after urgent CRPP. 4-7, 11, 15-20 The present study demonstrates the bene ts of a strategy of close observation following CRPP for the treatment of SHFs presenting with a PPH.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Xie¹,

Wang²,

Deng³

2020

Preprint

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Background: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. Methods: Thirteen children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery injury in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function. Conclusion: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular injury and determining treatment strategies.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Xie¹,

Wang²,

Deng³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In the case of pale pulseless hands, there is a chance that radial pulse may return after CRPP; otherwise, immediate vascular exploration is strongly indicated. In a PPH, the traditional strategy of close observation should not be revisited as long as there are no signs of deterioration of the vascular status [12].…”

Section: Discussionmentioning

confidence: 99%

“…Some clinicians recommend aggressive surgical exploration and vascular reconstruction due to the concern that delaying reconstruction of the artery will lead to compartment syndrome, ischemic contracture, retarded development of the limb, cold intolerance, and so on [3,8,[11][12][13][14][15]. Blakey et al reported a high incidence of compartment syndrome associated with a PPH following SHFs [16], and the incidence has been reported to increase from 0.2%-4.5% in cases with co-existing neurovascular compromise [17].…”

Section: Introductionmentioning

confidence: 99%

Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

Xie¹,

Wang²,

Deng³

2020

Preprint

View full text Add to dashboard Cite

Background: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand.Methods: Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function.Conclusion: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

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“…Urgent closed reduction and percutaneous pinning (CRPP) is the primary treatment in both situation, and vascular exploration is often required in the case of a pale pulseless hand [6][7][8][9][10][11]. However, the optimal treatment for a PPH in terms of whether to perform immediate vascular exploration or manage with close observation is controversial in cases where the radial pulse is still not palpable after CRPP [10][11]. Some clinicians recommend aggressive surgical exploration and vascular reconstruction due to the concern that delaying reconstruction of the artery will lead to compartment syndrome, ischemic contracture, retarded development of the limb, cold intolerance, and so on [3,[8][9][10][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

Xie¹,

Wang²,

Deng³

2020

Preprint

View full text Add to dashboard Cite

Background: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand.Methods: Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function.Conclusion: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies.

show abstract

Management of the Pediatric Pulseless Supracondylar Humeral Fracture: A Systematic Review and Comparison Study of “Watchful Expectancy Strategy” Versus Surgical Exploration of the Brachial Artery

Cited by 18 publications

References 37 publications

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands

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