Vascular complications of supracondylar humeral fractures in children

Abstract

The purpose of this study was to analyze the vascular complications of 24 children with supracondylar humeral fractures treated in two affiliated hospitals and to propose a management plan. Exploration and repair of the brachial artery were undertaken in 11 of the 24 cases in which the pulse did not resume following reduction of the fracture. The repaired vessels were found to be patent on follow-up. Angiography was performed in six of the 24 cases and resulted in improved management in comparison with cases in which no angiography was performed. We believe that intra-operative angiography and vascular repair are indicated in most cases in which a palpable pulse does not resume after fracture reduction.

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

“…Postoperative establishment of continuous anterior humeral and coronoid lines shows the success of surgical treatment. The percent and number of vascular complications was similar to the literature data (17,18). Myositis ossificans is an indicator of damaged soft tissue around the elbow and is associated with poorer functional outcomes.…”

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

“…Copley et al [6] reported that a formal angiography should be performed before surgery if either the pulseless limb has no clinical signs of severe ischaemia and the essence or location of the vascular injury remains unknown due to previous vascular pathology or combined limb trauma, or when a surgical exploration is being debated. Furthermore, intra-operative arteriography with the aid of a C-arm is a useful tool in cases in which the radial pulse is not palpable after an attempt of fracture reduction [15]. The same authors hold that the only contraindications for intraoperative arteriography are Gustilo type I and II open fractures, as well as severe ischaemia of the limb [15].…”

“…Furthermore, intra-operative arteriography with the aid of a C-arm is a useful tool in cases in which the radial pulse is not palpable after an attempt of fracture reduction [15]. The same authors hold that the only contraindications for intraoperative arteriography are Gustilo type I and II open fractures, as well as severe ischaemia of the limb [15].…”

“…On the contrary, some authors believe that these techniques do not have the specificity and sensitivity of angiography [23]. The latter is sufficient to define the extension and localisation of the vascular injury and provide the necessary information for the surgical plan [15]. Copley et al [6] reported that a formal angiography should be performed before surgery if either the pulseless limb has no clinical signs of severe ischaemia and the essence or location of the vascular injury remains unknown due to previous vascular pathology or combined limb trauma, or when a surgical exploration is being debated.…”

“…Doppler, magnetic resonance angiography and colour-flow duplex scanning are non-invasive techniques that may obtain anatomically and haemodynamically useful information. 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].…”