Supracondylar humerus fractures with associated vascular trauma in children

Abstract

Introduction Supracondylar humerus fractures have higher complication rates than any other pediatric fracture. The management of the associated vascular injuries is still a moot point. Purpose To analyze the outcomes of patients with supracondylar fractures and absent or decreased radial pulse. Materials and methods Retrospective study of 205 children with a displaced supracondylar fracture between 2002 and 2006. Results Of the 205 children with a supracondylar fracture, 11 had no radial pulse on admission. Six of the 11 children recovered it further to closed reduction and fixation with Kirschner wires. One of the 11 had no pulse following reduction and immobilization and 4 patients that presented with an ischemic hand required open reduction of the fracture and artery examination further to an angiographic assessment. In the last follow-up visit, none of them showed any problems. Conclusions Initial treatment for children with supracondylar fractures and no radial pulse must be closed reduction. Arteriography is the most appropriate pre- and intraoperative diagnostic tool to define the lesion and plan the surgery. Fracture reduction and blood supply restoration are important for limb salvage and avoidance of potential sequelae.