Microsurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in children

Noaman, Hassan Hamdy

doi:10.1002/micr.20277

Cited by 53 publications

(42 citation statements)

References 24 publications

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“…They are usually reported in cases of proximal and supracondylar humeral fractures. 5,6 Uncomplicated humeral shaft fractures are usually treated conservatively. The usual operative methods used are the dynamic compression plate (DCP) and intramedullary nail.…”

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confidence: 99%

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Boschi

Pogorelić²,

Gulan³

et al. 2013

Can J Surg

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RESEARCH • RECHERCHE Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series studyBackground: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. Methods:We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.Results: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. Conclusion:The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves. Contexte :Il existe peu d'approches chirurgicales pour corriger la fracture de la diaphyse humérale. Nous présentons ici les résultats que nous avons obtenus avec une approche sous-brachiale.Méthodes : Nous avons réalisé une série de cas rétrospective regroupant des patients ayant subi une chirurgie pour réparation de fracture de la diaphyse humérale entre janvier 1994 et janvier 2008. Nous avons divisé les patients en 4 groupes selon l'approche chirurgicale employée (antérieure, antérolatérale, postérieure et sousbrachiale). Nous avons utilisé une plaque de compression dynamique AO de 4,5 mm.Résultats : Pendant la période de l'étude, 280 patients de 30 à 36 ans ont subi une chirurgie pour fracture de la diaphyse humérale. La durée moyenne de la chirurgie a été la plus courte avec l'approche sous-brachiale (40 min). La perte moyenne de force musculaire a été de 40 %, 48 %, 42 % et 20 % avec les approches antérolatérale, postérieure, antérieure et sous-brachiale, respectivement. La perte moyenne de tension dans le muscle brachial après 4 mois était respectivement de 61 %, 48 %, et 11 % avec les approches antérolatérale, antérieure et sous-brachiale. Seize patients des groupes soumis aux approches antérolatérale et antérieure et 6 patients du groupe soumis à l'approche postérieure ont subi des lésions peropératoires du nerf radial. Aucune complication postopératoire n'a été observée dans...

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confidence: 99%

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Boschi

Pogorelić²,

Gulan³

et al. 2013

Can J Surg

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“…CCDS correctly identified arterial lesions and normal patency of the brachial artery was restored. Along with others, 4,12,14,17,26 we emphasise that in those cases, a satisfactory temporary collateral circulation could not have guaranteed a good long-term outcome. Cold intolerance, sometimes with Raynaud's phenomenon, dysaesthesia, claudication of the forearm, delayed development and growth arrest of the involved limb and complete loss of function have been reported following arterial damage associated with a supracondylar fracture.…”

Section: Discussionmentioning

confidence: 65%

“…Cold intolerance, sometimes with Raynaud's phenomenon, dysaesthesia, claudication of the forearm, delayed development and growth arrest of the involved limb and complete loss of function have been reported following arterial damage associated with a supracondylar fracture. 4,7,9,12,17 In Blakey et al's 4 series of 26 patients with a pink pulseless hand after reduction of the fracture with a mean follow-up of 15.5 years, only four had undergone an exploration, three immediately, when an arterial repair was possible and one 48 hours after the injury, which was unsuccessful. Thus, 23 patients developed an ischaemic contracture of the forearm and hand and they concluded that a pink pulseless limb is ischaemic and recommended urgent exploration under these circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…Similar good results with arterial microsurgical repair have also been reported. 2,9,12,17,24,25 In conclusion, we believe that following successful reduction of a supracondylar fracture, the traditional strategy of watchful waiting in children with a pink pulseless hand should be revisited. In some cases there may be severe injury to the brachial artery in spite of a compensatory collateral circulation.…”

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confidence: 99%

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The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children

Valentini

Farsetti

Martinelli

et al. 2013

The Bone & Joint Journal

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Of 48 consecutive children with Gartland III supracondylar fractures, 11 (23%) had evidence of vascular injury, with an absent radial pulse. The hand was pink and warm in eight and white and cold in the other three patients. They underwent colour-coded duplex scanning (CCDS) and ultrasound velocimetry (UV) to investigate the patency of the brachial artery and arterial blood flow. In seven patients with a pink pulseless hand, CCDS showed a displaced, kinked and spastic brachial artery and a thrombosis was present in the other. In all cases UV showed reduced blood flow in the hand. In three patients with a white pulseless hand, scanning demonstrated a laceration in the brachial artery and /or thrombosis. In all cases, the fracture was reduced under general anaesthesia and fixed with Kirschner wires. Of the seven patients with a pink pulseless hand without thrombosis, the radial pulse returned after reduction in four cases. The remaining three underwent exploration, along with the patients with laceration in the brachial artery and/or thrombosis.We believe that the traditional strategy of watchful waiting in children, in whom the radial pulse remains absent in spite of good peripheral perfusion should be revisited. Vascular investigation using these non-invasive techniques that are quick and reliable is recommended in the management of these patients. In displaced supracondylar fractures of the humerus in children, the incidence of an absent radial pulse, indicating a brachial artery injury, ranges from 2.6% to 20%.

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“…Supracondylar fracture of the humerus in children is one of the most common fractures seen in orthopaedic outpatient department all over the world accounting for 60% of all elbow fracture in children in the first decade of life [1]. Traditionally this type of fracture is associated with high rate of malunion, nerve injuy, and vascular complications [2].…”

Section: Discussionmentioning

confidence: 99%

Fixation of Supracondylar Humeral Fracture in Children by Medial and Lateral Pinning Versus Lateral Pinning

Khairy¹

2016

MOJOR

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Microsurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in children

Cited by 53 publications

References 24 publications

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children

Fixation of Supracondylar Humeral Fracture in Children by Medial and Lateral Pinning Versus Lateral Pinning

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