The pulseless supracondylar humeral fracture: Our experience and a 1-year follow-up

Delniotis, Ioannis; Ktenidis, Kiriakos

doi:10.1097/ta.0000000000002007

Cited by 7 publications

(13 citation statements)

References 22 publications

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“…1,17,18 Of pulseless type III supracondylar humerus fractures, 52% to 90% remain perfused, whereas the remaining are unperfused. 6,11,17,19 The operative and postoperative management of patients with perfused pulseless supracondylar humerus fractures is debated in the literature. This is a retrospective review of the 39 patients with perfused pulseless supracondylar humerus fractures and sought to evaluate the duration of postoperative inpatient stay and timing of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…16.8% of type III supracondylar humerus fractures present pulseless 1,17,18. Of pulseless type III supracondylar humerus fractures, 52% to 90% remain perfused, whereas the remaining are unperfused 6,11,17,19. The operative and postoperative management of patients with perfused pulseless supracondylar humerus fractures is debated in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Delniotis et al6 performed a systematic review to evaluate the outcomes of close monitoring postoperatively versus immediate surgical exploration in patients with persistently perfused pulseless hands after reduction. They found that in patients who underwent angiography or duplex scanning, 100% underwent exploration, and in those who were evaluated only by clinical signs, doppler, and capillary refill, none underwent exploration, with no long-term differences in outcomes between the 2 groups 6,7. Soh et al21 recommend the use of a pulse oximeter intraoperatively in patients who remain pulseless but perfused after reduction; in the 4 patients with poor or absent wave forms, all had pertinent findings on vascular exploration.…”

Section: Discussionmentioning

confidence: 99%

“…The perfusion status of the pediatric upper extremity in the setting of a supracondylar humerus fracture is a topic of great interest to the orthopaedic surgeon. The “pink and pulseless” supracondylar humerus fracture is well described in the literature regarding the need for intervention, the timing of operative care, risk factors for vascular injuries, and postoperative outcomes 1–9. It is theorized that the hand remains perfused due to rich collateral flow around the elbow 1,4.…”

mentioning

confidence: 99%

“…The "pink and pulseless" supracondylar humerus fracture is well described in the literature regarding the need for intervention, the timing of operative care, risk factors for vascular injuries, and postoperative outcomes. [1][2][3][4][5][6][7][8][9] It is theorized that the hand remains perfused due to rich collateral flow around the elbow. 1,4 The need to immediately intervene on patients with perfused but pulseless hands is often debated.…”

mentioning

confidence: 99%

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A Modern Day Timeline for In-Hospital Monitoring in Perfused, Pulseless Pediatric Supracondylar Humerus Fractures

Heyer

Mitchell

Garcia

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The perfused, pulseless supracondylar humerus fracture (ppSCHF) remains a consistent topic of discussion in the literature. Inpatient observation of these patients postoperatively for worsening vascular exam or compartment syndrome is frequently recommended but not well studied. The purpose of this study was to evaluate the postoperative complications in a cohort of ppSCHF patients and their timeline to discharge. Methods: This study is a retrospective review of a prospectively maintained database of all operatively treated supracondylar humerus fractures from a tertiary pediatric hospital from 2013 to 2019. All patients without a palpable pulse were included. We excluded patients with <4 weeks follow-up. Demographic, operative, and postoperative data were collected, including time from presentation to operating room (OR), time from OR to discharge, and incidence of postoperative complications, including return to OR, compartment syndrome, new neurovascular deficits, and Volkmann contractures. The descriptive statistics were used to summarize the data. Results: Among 1371 operatively treated supracondylar humerus fractures, 39 (2.8%) presented with a ppSCHF. Five (15%) had a signal on doppler ultrasound, whereas 34 (85%) had no signal. Thirty-seven (95%) patients had a Gartland type III fracture and 2 (5%) had type IV fractures. Twenty-two (56%) patients had a neurological deficit, of which 14 had an anterior interosseous nerve deficit. The average time to OR was 6.9 (range 2.2 to 15) hours; 6 (15%) required open reduction. At the time of discharge, 85% of patients had a palpable pulse and 13% had a dopplerable signal. Postoperatively, no patients were returned to the OR for any secondary procedures. The average length of stay after the operation was 25 (range 8.5 to 40) hours, with 92% of patients being discharged by 36 hours postoperatively. No patients developed compartment syndrome, new neurological deficits, or Volkmann contractures at a mean follow-up of 112 (range 34 to 310) days. Conclusions: In our study of 39 patients presenting with ppSCHF, no patient required an unexpected return to the OR, or developed post-treatment compartment syndrome, neurological deficits, or Volkmann contractures. The average time from OR to discharge for ppSCHF was 25 hours. Level of Evidence: Level II.

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