Chronic hand ischemia in pediatric patients due to brachial artery injury after supracondylar humerus fracture.

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Brachial artery injury due to displaced supracondylar fracture (SC) of the humerus in children may present with pink pulseless hand (PPH), denoting a well perfused hand without radial pulse, or acute hand ischemia. Some reports state that brachial artery reconstruction is not necessary in children with persisting PPH, but the reports on long-term consequences such as intermittent claudications, growth retardation and ischemic contracture in children with pulseless hand are scarce and often misinterpreted. The objective of our analysis was to assess the long-term outcomes of children with brachial artery injury associated with SC fracture. A retrospective review was performed and data on all children treated for SC fracture with brachial artery injury from 2010 to 2022 were collected. Functional outcomes, brachial artery patency and complications were analyzed. Overall, 10 patients with acute ischemia or PPH persisting after fracture reduction/fixation were identified, and all underwent brachial artery exploration (age range 3-10 years). Six patients underwent immediate exploration after fracture reduction and fixation: three due to signs of acute ischemia, and three for persisting PPH. Two patients underwent vascular surgery for PPH that persisted for more than 48 hours following fracture reduction. Two patients were discharged and later developed intermittent claudications/critical ishemia requiring revascularization. Mean follow up was 3.5 years (ranged 2-6 years). There were no postoperative complications. All patients had a palpable radial pulse, patent brachial artery on the last follow-up examination and no signs of ischemic contracture. Brachial artery reconstruction after SC fracture with brachial artery injury is a safe procedure that offers excellent long-term patency. Revascularization should be done in all patients with persistently absent radial pulse to avoid chronic hand and forearm ischemia.