Orthopedic pitfalls in the ED: Pediatric supracondylar humerus fractures

Arterial Damage Accompanying Supracondylar Fractures of the Humerus

“…It is important to point out that the underlying cause of arterial insufficiency in a small number of cases presenting with supracondylar fracture/ dislocation may simply be arterial spasm (1). Although less invasive treatment by closed reduction and release of the entrapped artery, in retrospect, may be the better choice; immediate surgery does not seem to cause any additional morbidity (7).…”

“…Arterial injury ranges anywhere from vascular contusion and intimal damage, to complete arterial transection (5,6). The dreaded vascular complications include brachial artery occlusion and possible limb loss, compartment syndrome or, Volkmann's contracture (1). Another possible long-term vascular complication is limb claudication (due to inadequate repair of the brachial artery or distal thrombus migration, with impeded blood flow) (2).…”

“…Nonvascular complications include deformity and neurologic injury (median, ulnar, and radial nerves). The anterior interosseous nerve, a branch of the median nerve being most commonly involved (20-45% of all nerve injuries) (1). Prevention of these complications depends largely on a timely diagnosis, aggressive treatment, and a high index of suspicion in a child with a suggestive history and physical exam.…”

“…Prevention of these complications depends largely on a timely diagnosis, aggressive treatment, and a high index of suspicion in a child with a suggestive history and physical exam. In evaluation of supracondylar fractures of the humerus, the physician must pay close attention to the neurovascular exam (1). Failure to assess a distal pulse in a patient may result in the loss of thechild's limb.…”

“…It mostly occurs by falling on an out-stretched hand (FOOSH) (1). Due to the frequency of falls, 65-75% of all fractures in this age group affect the upper extremities (2).…”