Treatment of Pink Hand Syndrome (Pulsless Hand) Post Supracondylar Humeral Fractures in Pediatrics

Abstract

Objectives: To review and present our experience at King Hussein Medical Centre, in the management of pink pulseless hand syndrome (PPHS ), and to analyse the results and outcome of the conservative watchful approach in the paediatric age group of patient presenting with PPHS, following Gartland type III humeral supracondylar fracture closed reduction and percutaneous pinning fixation (CRPP). Methods: This is a retrospective study, conducted at King Hussein Medical Centre, on patients aged 14 years and below (Paediatric age group) who sustained grade III Gartland supracondylar fracture of humerus (SCFH) and developed pulseless hands post fracture fixation, between the period of January 2016 and December 2021. Results: Among 533 patients with the age group of 14 years and below presented to the emergency department with SCFH, 196 patients had type III Gartland SCFH. Post CRPP, 125 (63.8%) had normal vascularity with intact pulses, 45 (22.9%) patients were found to have absent pulses with cold pale poorly perfused hands. Twenty six patients (13.3%) had absent pulses, but well perfused well perfused pink hands. During the admission, only two patients (6.7%) among the 24 patients experienced worsening of the perfusion in the involved extremity and underwent emergency exploration of the brachial artery restoration of hand perfusion successfully post operation. Twenty four (92.3%) patients had well perfused hands within 48 hours of in hospital admission period and were successfully discharged. Conclusion: Patients presenting with pink pulseless hand syndrome post fracture reduction and stabilization can be safely observed with in hospital admission and strict monitoring of perfusion of the involved hand with no significant sequel and with successful results.