Pediatric brachial artery injury due to supracondylar humerus fractures: A case series.

Abstract

Objectives Two to 20% of pediatric supracondylar humerus fractures present with abnormal vascular examinations ranging from ischemic hands to perfused pulseless hands. Management of perfused pulseless hands with observation or surgical exploration remains debatable. We report management and outcomes of five cases at our institution. Methods Charts of patients <18 years old with supracondylar humerus fractures undergoing brachial artery exploration from 2009 to 2016 were reviewed. Results Five patients presented with supracondylar humerus fracture after falls. Closed reduction and percutaneous pinning resulted in five pink hands, one with a palpable pulse and one with return of radial Doppler signal. Two were admitted for observation and one underwent immediate brachial artery exploration. The four cases initially managed non-operatively underwent exploration. Intraoperative findings included three brachial artery entrapments, one arterial compression due to hematoma, and one complete arterial transection requiring thrombectomy and venous interposition graft. At follow-up, all patients had palpable radial pulses. Conclusions Perfused pulseless hands after supracondylar humerus fracture reduction require close monitoring. Cases without return of radial Doppler signals should undergo immediate brachial exploration. We recommend duplex ultrasound for the diagnosis of brachial artery injury as an early guide to surgical exploration to prevent treatment delay and arm or hand ischemia.