Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series

Int Orthop. 2018 Apr;42(4):891-899. doi: 10.1007/s00264-017-3698-5. Epub 2017 Nov 30.

Abstract

Purpose: The management of pulseless supracondylar fractures remains controversial. The aims of this study were to: (1) analyse functional and vascular outcomes of conservative treatment for cases with absent pulse before reduction, whether patients showed limb ischaemia or not; and (2) identify factors associated with vascular complications.

Methods: Twenty-seven children with absent pulses on presentation were treated consecutively between 1999 and 2009. The brachial artery was surgically explored in cases of persistent signs of ischaemia after reduction. Signs of vascular impairment were recorded in the early post-operative period and at a mean final follow-up of 3.5 years.

Results: Recurrent ischaemia with a compartment syndrome occurred in a patient with initial ischaemia and a pink, pulseless hand after reduction. Patients with an initially well-perfused hand and those with pre-operative ischaemia and palpable pulses after reduction had satisfactory outcomes, as did patients with early arterial exploration. No patient showed signs of chronic vascular impairment. The need for vascular repair was significantly correlated with open fracture, initial ischaemia and nerve impairment.

Conclusions: Conservative management of supracondylar fractures with absent pulses avoided long-term vascular complications provided that patients with a pulseless, well-perfused hand on presentation were closely monitored after reduction. Further study is necessary to determine whether a forearm Doppler would help identify children with absent pulses after reduction who need surgical revascularisation due to an insufficient collateral circulation.

Keywords: Children; Compartment syndrome; Fracture; Humerus; Ischemia; Supracondylar; Volkmann contracture.

MeSH terms

  • Adolescent
  • Brachial Artery / injuries*
  • Brachial Artery / surgery
  • Child
  • Child, Preschool
  • Conservative Treatment / adverse effects
  • Conservative Treatment / methods*
  • Female
  • Fracture Fixation / adverse effects
  • Fracture Fixation / methods
  • Hand / blood supply
  • Humans
  • Humeral Fractures / complications
  • Humeral Fractures / therapy*
  • Infant
  • Ischemia / etiology
  • Male
  • Pulse
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Vascular System Injuries / etiology*
  • Vascular System Injuries / therapy