Anomalous Brachial Artery Bifurcations Can Be at Increased Risk for Entrapment in Pediatric Supracondylar Humerus Fractures, but Do Not Alter Practice Guidelines

Abstract

Limb-threatening events arising subsequent to fixation of pediatric supracondylar humerus (SCH) fractures are infrequent. We experienced an untoward pulseless hand in a 9-year-old boy subsequent to reduction and fixation of a SCH fracture with unremarkable preoperative neurovascular examination. A dilemma persists in consideration of parameters to assess limb perfusion from an array of investigations. Recently, clinical practice guidelines in the management of pediatric SCH have been established based on appropriate use criteria and in compliance, we undertook vascular exploration. We observed a variant of high brachial artery bifurcation entrapped in the fracture site. The injuries were appropriately managed without complications and had excellent outcomes in a follow-up period of 11 months. This index case report of a preexisting brachial artery bifurcation variant associating a limb-threatening event in postoperative period also highlights the effective utility of the current practice guidelines in management of pediatric SCH fractures.