“A journey from doom to bloom” – A rare case of low-energy pediatric open supracondylar fracture of humerus with brachial artery laceration managed with “Orthoplastic Approach”

Abstract

Supracondylar fracture of the humerus (SFH) is the most common fracture of the elbow in the pediatric population (60%). The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability, and commonly, it is associated with road traffic accidents (RTAs) and occupational injuries. However, brachial artery injury in the pediatric age group is not very frequent as in adults and commonly associated with SFH. Long-term sequelae of ischemia in the forearm such as Volkmann's ischemic contracture may prove disastrous. Early aggressive management in terms of exploration of the brachial artery is recommended by Blakey et al., to prevent such serious complications. Arterial injury ranges anywhere from vascular contusion and intimal damage, to complete arterial transaction. Low-velocity injuries such as falls or sports injuries can cause isolated Type 1 open fractures (Gustilo and Anderson classification of open fractures). Open supracondylar fracture complicated by brachial artery laceration is usually seen in high-velocity injuries such as RTA and is usually a part of multiple injuries sustained in such patients. However, in search of literature, we have not found an isolated Type 3 open supracondylar fracture with brachial artery laceration following a fall from a speeding bicycle, which is considered as a low-energy trauma. This patient was managed with reduction and fixation of the fracture with crossed K-wires and repair of the brachial artery with interpositional reversed saphenous vein graft to save the limb.