Long-term Follow-up of Vascular Reconstructions after Supracondylar Humerus Fracture with Vascular Lesion in Childhood

Kempler, Péter; Fritz, G. A.; Ott, T.; Weiglhofer, U.; Schweiger, S; Cohnert, Tina

doi:10.1016/j.ejvs.2011.06.028

Cited by 20 publications

(7 citation statements)

References 12 publications

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“…Konstantiniuk et al showed in a 14-year follow-up, that surgical reconstruction of the brachial artery is an effective therapy in regard of blood supply and growth. Still, in 7 of 10 patients they found an ectatic lesion of the saphenous vein graft [8] .…”

Section: Discussionmentioning

confidence: 92%

“…Vascular compromise can be caused by arterial rupture, kinking, compression, spasm or intimal lesion and incidence increases depending on the degree of dislocation [7] . Growth-retardation can be result of conservative therapy of vascular trauma [8] . Even after reduction of the fracture, in up to 47% of the patients with initially vascular compromise, the hand remains pulseless but perfused due to entrapment of the brachial artery within the fracture side.…”

Section: Discussionmentioning

confidence: 99%

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Neurovascular complications after supracondylar humerus fractures in children

Leiblein

Lustenberger

Schulz

et al. 2017

Trauma Case Reports

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BackgroundSupracondylar fractures of the humerus are a common injury in pediatric traumatology. The most common operative therapy is closed reduction and percutaneous pinning using K-wires. Common complications associated with this entity are neurovascular lesions, especially of the brachial artery and the median nerve.MethodsWe report two cases of patients treated in our trauma-center with supracondylar fracture of the humerus (AO IV°) and neurovascular complications.ResultsBoth patients underwent open revision and recovered completely in their further course.ConclusionWe recommend detailed neurovascular examination initially and after reposition of the fracture. The threshold for open reduction in cases of irreducible fractures should be low. In the presence of neurovascular impairment an open revision is mandatory, even months after the initial Trauma.Level of evidence: Level V (case report).

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Neurovascular complications after supracondylar humerus fractures in children

Leiblein

Lustenberger

Schulz

et al. 2017

Trauma Case Reports

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“…Despite the outcomes of conservative management, many surgeons-especially vascular or microsurgical surgeons-tend to recommend surgical exploration and vascular reconstruction after CRPP for a PPH, with good results reported. 9,13,14,30 Immediate surgical exploration before fracture reduction has even been recommended, 14 although disadvantages of the procedure have been reported to include a long scar and the occurrence of re-occlusion and stenosis of the brachial artery. 21,28 Surgical exploration is recommended for three main reasons: the rst is that ligation of an injured brachial artery is considered to be associated with a high amputation rate based on war-time reports.…”

Section: Discussionmentioning

confidence: 99%

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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“…Others recommend aggressive surgical treatment and reconstruction of damaged vessels [14, 32, 35], because reliance on collateral flow in the forearm may leave the hand viable and, however, puts the child at risk for long-term sequelae such as contractures and limb length discrepancy [11, 14]. In some studies, radical treatments with interposition of the greater saphenous vein or the basilic vein for reconstruction of the brachial artery obtained very good and promising results [14, 36]. In our opinion, each case should be considered individually.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation

Tomaszewski

Wozowicz

Wysocka-Wojakiewicz

2017

BioMed Research International

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Purpose. Analysis of early vascular and nerve complications of supracondylar humerus fractures in children. Material and Methods. 220 children hospitalized in the Pediatric Trauma-Orthopedic Department in the years 2004–2014. The group consisted of 143 males and 77 females. Results. Acute neurovascular complications occurred in 16.81% of patients with displaced supracondylar fracture (37 children). Nerve damage was found in 10% of patients with displaced fracture (22 children). The most injured nerve was median nerve; this complication occurred in 15 patients (68.18%). The total nerve function returned after average of 122 days (0–220 days after surgery). Symptoms of vascular injury occurred in 7.7% children with displaced fracture (17 children). Conclusions. (1) In children with supracondylar fracture the most often injured nerve is median nerve. (2) The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification.

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Long-term Follow-up of Vascular Reconstructions after Supracondylar Humerus Fracture with Vascular Lesion in Childhood

Cited by 20 publications

References 12 publications

Neurovascular complications after supracondylar humerus fractures in children

Neurovascular complications after supracondylar humerus fractures in children

Treatment of Pediatric Supracondylar Humerus Fractures accompanied with Pink Pulseless Hands

Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation

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