Less is More in the Nonoperative Management of Complete Brachial Artery Transection after Supracondylar Humeral Fracture

Wolfswinkel, Erik M.; Weathers, William M.; Siy, Richard; Horowitz, Kevin; Hollier, Larry H.

doi:10.1016/j.avsg.2013.04.029

Cited by 9 publications

(14 citation statements)

References 13 publications

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“…10,31 However, these cases are very different to SHFs, in which the arm can be kept alive even with ligation of the brachial artery due to the collateral circulation. 17,[26][27][28] Two of our cases underwent CRPP nearly 2 days after injury because of neglect of artery injury and late referral; however, the pulse recovered in 6 hours in both. This con rms the suggestion from previous studies that collateral circulation is su cient to support the vitality of a PPH following SHFs, even without fracture reduction.…”

Section: Discussionmentioning

confidence: 79%

“…26,27,28 Strong collateral circulation has been identi ed using arteriography or ultrasound around the elbow after SHFs. 17 Furthermore, CFDU also detected collateral circulation around the elbow even though the radial pulse was not palpable.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional conservative strategy of close observation has been used for SHFs since 1950s and relies on collateral circulation of the elbow joint. 10,17,[23][24][25] Studies have demonstrated that the limb can kept alive with ligation of the injured brachial artery. 26,27,28 Strong collateral circulation has been identi ed using arteriography or ultrasound around the elbow after SHFs.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Xie¹,

Wang²,

Deng³

2020

Preprint

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Background: The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. Methods: Thirteen children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery injury in most cases. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Results: Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed; therefore, no surgical exploration was performed. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. All patients achieved excellent limb function. Conclusion: Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. Surgical exploration is not necessary as long as the hand is warm and well perfused. Color-flow Duplex ultrasound is beneficial for assessing vascular injury and determining treatment strategies.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Xie¹,

Wang²,

Deng³

2020

Preprint

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“…Color duplex scanning and ultrasound velocimetry have been shown to have some benefit in evaluating children for vascular injury and in evaluating the possible need for vascular exploration. 23,24 Other studies have confirmed that patients with a pink hand with capillary refill (and no palpable or Doppler pulses) after reduction and pinning can be safely observed 25,26 ; however, some of these children develop evidence of worsening ischemia and require exploration and thus close observation is paramount. Many authors have noted the association between neurologic deficit and vascular injury in these fractures, and the absence of return of median nerve function in the forearm and hand after CRPP may be an indication for surgical exploration.…”

Section: Other Causes Of Closed Arterial Damagementioning

confidence: 92%

Acute Ischemia of the Upper Extremity

Pederson

2016

Orthopedic Clinics of North America

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“…Treatment of non-displaced fractures (type I) is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing (9,10). Treatments of displaced supracondylar fractures (type II and III) of the humerus in children are still undefined in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

Stefanovic

Vukašinović

Stankovic

et al. 2017

Serbian Journal of Experimental and Clinical Research

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Less is More in the Nonoperative Management of Complete Brachial Artery Transection after Supracondylar Humeral Fracture

Cited by 9 publications

References 13 publications

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Acute Ischemia of the Upper Extremity

Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

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