Management of Vascular Injuries in Displaced Supracondylar Humerus Fractures without Arteriography

Shaw, Brian A.; Kasser, James R.; Emans, John B.; Rand, Frank

doi:10.1097/00005131-199003000-00004

Cited by 162 publications

(101 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With regard to vascular injury, 10-20% of patients with a type III supracondylar fracture present with an absent pulse [30,31,34]; this condition is called ''pulseless supracondylar humerus fracture''. There is controversy about treatment if the pulse does not return but the hand is well perfused.…”

Section: Discussionmentioning

confidence: 99%

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Mazzini

Martín

Esteban

2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose There is no clear evidence in the actual literature regarding which of the surgical approaches could bring about the best functional, cosmetic, and radiological outcomes, as well as fewer complications, when an open reduction and pinning of a severely displaced supracondylar humerus fracture is performed. We, therefore, performed a systematic review of the English literature to investigate the existing evidence regarding this issue. Methods A MEDLINE and EMBASE databases search was performed to identify articles that focused on the functional, cosmetic, and radiological outcomes, as well as post-surgical complications, regarding different surgical approaches used for open reduction and pinning in severely displaced supracondylar humerus fractures in children. One hundred and ninety-four articles were identified, of which seven were included for review. Data analysis included weighted means for all contingency tables and the Chi-square test. Standardized residues were studied when the Chi-square test was statistically significant. Statistical analyses were conducted using Stata 9.1/SE (StataCorp., College Station, TX) and P-values lower than 0.05 were considered to be statistically significant for all analyses. Results For functional outcome, a high frequency of excellent results was found within the lateral and medial approaches, and a high frequency of good results within the anterior approach. A high frequency of poor results was found within the posterior approach. For cosmetic outcome, there was a high frequency of fair results within the posterior and lateral approaches, and a high frequency of poor results within the posterior approach. No statistically significant difference regarding time to union, as well as complications, was found. Conclusion Our results suggest that a combined anteromedial approach could be the method which allows the achievement of better functional and cosmetic outcome according to Flynn's criteria. Time to union, as well as post-surgical complications, should not be an issue regarding surgical approaches used for open reduction and pinning in these fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Mazzini

Martín

Esteban

2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…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%

“…Angiography is an invasive technique that can be performed either before surgery in the angiography suite or in the operating room, with the aid of a C-arm [15]. Its role in the investigation of an absent radial pulse is still under debate [5,24]. It is our opinion that angiography should not be performed before surgery in cases of a pink pulseless hand.…”

Section: Discussionmentioning

confidence: 99%

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

Korompilias

Lykissas

Mitsionis

et al. 2008

International Orthopaedics (SICO

View full text Add to dashboard Cite

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.

show abstract

“…[1][2][3][4] In those with an arterial injury the fracture is usually a posterolaterally displaced Gartland 5 type III injury, [6][7][8] with additional involvement of the median nerve or its anterior interosseous branch in 12% to 20% of cases. 4,[9][10][11][12] In some children with mild symptoms, the level of suspicion for arterial injury is low and many authors suggest that a patient with a pulseless but pink and warm hand should be managed expectantly after reduction of the fracture, assuming that the arterial spasm would resolve and collateral circulation would compensate for the temporary circulatory impairment.…”

mentioning

confidence: 99%

“…4,[9][10][11][12] In some children with mild symptoms, the level of suspicion for arterial injury is low and many authors suggest that a patient with a pulseless but pink and warm hand should be managed expectantly after reduction of the fracture, assuming that the arterial spasm would resolve and collateral circulation would compensate for the temporary circulatory impairment. 1,[12][13][14] However, others have questioned this approach 2,12,14,15 and Blakey et al 4 reported that 23 of 26 children with a pink, pulseless hand faced ischaemic complications in the long-term.…”

mentioning

confidence: 99%

The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children

Valentini

Farsetti

Martinelli

et al. 2013

The Bone & Joint Journal

View full text Add to dashboard Cite

Of 48 consecutive children with Gartland III supracondylar fractures, 11 (23%) had evidence of vascular injury, with an absent radial pulse. The hand was pink and warm in eight and white and cold in the other three patients. They underwent colour-coded duplex scanning (CCDS) and ultrasound velocimetry (UV) to investigate the patency of the brachial artery and arterial blood flow. In seven patients with a pink pulseless hand, CCDS showed a displaced, kinked and spastic brachial artery and a thrombosis was present in the other. In all cases UV showed reduced blood flow in the hand. In three patients with a white pulseless hand, scanning demonstrated a laceration in the brachial artery and /or thrombosis. In all cases, the fracture was reduced under general anaesthesia and fixed with Kirschner wires. Of the seven patients with a pink pulseless hand without thrombosis, the radial pulse returned after reduction in four cases. The remaining three underwent exploration, along with the patients with laceration in the brachial artery and/or thrombosis.We believe that the traditional strategy of watchful waiting in children, in whom the radial pulse remains absent in spite of good peripheral perfusion should be revisited. Vascular investigation using these non-invasive techniques that are quick and reliable is recommended in the management of these patients. In displaced supracondylar fractures of the humerus in children, the incidence of an absent radial pulse, indicating a brachial artery injury, ranges from 2.6% to 20%.

show abstract

Management of Vascular Injuries in Displaced Supracondylar Humerus Fractures without Arteriography

Cited by 162 publications

References 0 publications

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

Surgical approaches for open reduction and pinning in severely displaced supracondylar humerus fractures in children: A systematic review

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

The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children

Contact Info

Product

Resources

About