Strategy of pulseless pink supracondylar humerus fracture treatment in children: a comparison of two approaches

Štichhauer, Radek; Preis, J; Plánka, Ladislav; Turek, Jakub; Urban, J; Horák, Zbyněk; Zeman, J; Konečný, Martin; Kopáček, Ivo; Hanák, Filip; Vojta, Jiří; Chrenková, Veronika

doi:10.1007/s00068-021-01794-x

Cited by 5 publications

(8 citation statements)

References 24 publications

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“…On the other hand, a fraction of surgeons advocate for a more conservative "watch and wait" approach after an immediate closed reduction in cases of "pink hand syndromes", a strategy corroborated by some literature [31]. Nevertheless, findings from Stichhauer et al revealed that out of their 125 pink pulseless hand cases post-SCHF, 9% necessitated vascular repair [32]. Concurrently, Delniotis et al, through a comprehensive systematic review, illustrated that post-closed reduction, the reappearance of a radial pulse in pink hands was observed in merely 30%.…”

Section: Discussionmentioning

confidence: 95%

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years

Wagner,

Boeriu,

Eberz

et al. 2023

Children

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To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.

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Section: Discussionmentioning

confidence: 95%

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years

Wagner,

Boeriu,

Eberz

et al. 2023

Children

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“…Khan et al [8] recommend observation for patients with an isolated vascular injury, however, in the presence of a concurrent nerve injury, early surgical exploration is recommended due to the high possibility of concurrent serious vascular injury. Štichhauer et al [6] conclude that there are no statistical benefits in the outcomes of either strategy and thus do not lean toward the choice of either intervention. The choice of the strategy employed was up to personal preference.…”

Section: Resultsmentioning

confidence: 99%

“…However, 93.7% (223/238) of all cases that underwent observation had a successful return of pulse, from 30 min [9] to 3 months [8,25], however, 6.3% (15/238) of cases had to undergo secondary exploration due to reasons such as a persistent absent pulse or the development of complications such as ischemia or signs of compartment syndrome [32]. Procedures carried out during surgical exploration included venous grafts, thrombectomies and patch angioplasties [6,17]. These decisions were made by the pediatric orthopedic surgeons from 24 h [9] up to 3 weeks [25] postreduction of the fracture.…”

Section: Resultsmentioning

confidence: 99%

“…However, the decision to surgically explore the BA in a well-perfused, pulseless hand remains a controversial one among vascular and orthopedic surgeons. While there have been other systematic reviews performed on this topic [4,5], since then, new primary research has emerged to shed more light on this age-old conundrum [6][7][8][9]. As such, we think it is appropriate to revisit this topic to provide an update on the management of pink pulseless SCHFs.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of paediatric pulseless pink humerus supracondylar fractures

Goh,

Ong,

Lee

et al. 2023

Journal of Pediatric Orthopaedics B

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The supracondylar humeral fracture (SCHF) is the most common fracture seen in children, forming up to 70% of all pediatric elbow fractures. The decision to surgically explore the brachial artery in a well-perfused, pulseless arm remains a controversial one among vascular and orthopedic surgeons and is something we seek to explore in this article. We reviewed the literature from electronic databases such as PubMed and Embase for studies focusing on the management of the pink pulseless hand (PPH) following SCHF. We gathered a total of 23 articles to be analyzed in this review. We found 336 PPH postreduction and evaluated the management as well as the follow-up and complications of the PPH involved. Most recent articles have cited the close observation strategy as the most reliable strategy. It is clear that the management of a SCHF requires immediate reduction and fixation. In the management of a postoperatively pulseless pink humerus, we do agree with the latest conclusion of Delionitis et al. who advocate the traditional dogma of watchful waiting in the case of a PPH postreduction and fixation as long as no signs of vascular deterioration appear. However, the outcome of this study also advocates for the monitoring of up to 24–48 h postreduction and the use of noninvasive tools such as ultrasound Doppler, Color flow duplex Ultrasound and pulse oximetry to monitor perfusion as they all have had good outcomes in the articles cited in this review. Still, in the event of vascular deterioration or development of complications of the hand, immediate vascular exploration is still indicated.

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“…Keine Einigkeit hingegen besteht bezüglich der Behandlung einer rosafarbenen, aber pulslosen Hand, und dies auch nicht, wenn nach der Reposition der Fraktur immer noch eine eingeschränkte Durchblutung vorliegt. Teils wird zum Zuwarten unter klinischer Überwachung ("wait-and-watch"), teils zur sofortigen operativen Exploration der A. brachialis geraten [4].…”

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Rosig und Pulslos – eine suprakondyläre Fraktur des distalen Humerus mit indirekter Einschnürung der Brachialarterie bei einem 4-jährigen Jungen

Krickl

Thannheimer

Noeldeke

et al. 2023

Handchir Mikrochir Plast Chir

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FallberichtBei einem 4-Jährigen mit starker Schwellung bei einer dislozierten suprakondylären Humerusfraktur vom Typ Laer IV (Abb. 1) fand sich bei der klinischen Untersuchung eine rosige, jedoch pulslose Hand. Die periphere Sensibilität war intakt, und die Kennmuskelfunktionen der oberen Extremität zeigten, soweit klinisch prüfbar, einen vollen Kraftgrad (Janda 5/5). Die Rekapillarisationszeit war hochnormal mit ca. zwei Sekunden. Allerdings war ein Puls der A. radialis bzw. A. ulnaris weder tast- noch dopplerbar.

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Strategy of pulseless pink supracondylar humerus fracture treatment in children: a comparison of two approaches

Cited by 5 publications

References 24 publications

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years

Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years

Systematic review of paediatric pulseless pink humerus supracondylar fractures

Rosig und Pulslos – eine suprakondyläre Fraktur des distalen Humerus mit indirekter Einschnürung der Brachialarterie bei einem 4-jährigen Jungen

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