Supracondylar fracture humerus with pink pulseless hand and angiogram confirmed vascular injury – Case report

Abstract

Supracondylar fracture of the humerus is a common injury in paediatric population. Neurovascular damage is a well-known serious complication of this injury. This should be managed urgently by the treating clinician in order to prevent severe disability to the child. In this case report, we illustrate the presentation, management and follow up of a 7-year-old boy presented with a supracondylar humerus fracture, highlighting the diagnostic and therapeutic measures taken in sequential manner.
 The child presented following a domestic fall and having pain, swelling and acute deformity of the left elbow. Clinically, no distal radial pulse or oxygen saturation using pulse oximetry detected on admission, even though the left hand was warm and pink with normal capillary refill time. X-ray confirmed the clinical diagnosis of supracondylar fracture humerus, and it was classified as Gartland type III.
 Manipulation and casting done without internal fixation on the next available casualty list and even after 72 hours of the procedure no return of distal pulse despite warm, pink hand. After vascular opinion, CT Angiogram revealed no flow segment of 2.2cm of brachial artery at the trauma site and minimum demonstrable flow distally. However, watchful waiting was selected as the management option by both vascular and orthopaedic teams as this child continues to have warm, pink hand with normal capillary refilling and minimal pain.
 In 6 months follow up, the child has gained both radial and ulnar pulses, full range of elbow motion, complete neurological recovery and good hand function.