Supracondylar Fractures With Circulatory Failure After Reduction, Pinning, and Entrapment of the Brachial Artery: Excellent Results More Than 1 Year After Open Exploration and Revascularization

Reigstad, Ole; Thorkildsen, Rasmus; Grimsgaard, Christian; Reigstad, Astor; Røkkum, Magne

doi:10.1097/bot.0b013e3181db276a

Cited by 22 publications

(17 citation statements)

References 24 publications

(28 reference statements)

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“…In the current literature, only a few reports about delayed neurovascular complications exist [23–25]. In fact, an excellent clinical long-term outcome can be expected if postoperative circulatory failure is treated immediately [24]. In general, artery entrapment syndromes, for example caused by a humeral bony spur, are usually clinically unapparent and symptoms only occur with specific movements, such as extension or flexion of the elbow [26, 27].…”

Section: Discussionmentioning

confidence: 99%

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

et al. 2017

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BackgroundSeverely displaced supracondylar fractures of the humerus in children are frequently associated with complications including neurovascular injuries, non-union, or compartment syndrome. In the current literature, no report exists about postoperative brachial artery entrapment in combination with an inconspicuous preoperative neurovascular examination.Case presentationWe present a case of a 6-year-old white boy with a pulseless radial and ulnar artery after open reduction and internal fixation of a severely displaced supracondylar fracture of his right humerus (Gartland type III) using four K-wires. Remarkably, the preoperative neurovascular examination was inconspicuous. Doppler ultrasound of his brachial artery revealed no pulse when his elbow was in flexion and a faint pulse when it was in full extension 10 hours postoperatively. Revision surgery was performed immediately. On intraoperative examination, a kinking of his brachial artery caused by an entrapment of the tunica externa in the reduced fracture was seen and the artery was released by microsurgical arteriolysis immediately. At the final follow-up examination, positive palpable pulse with good capillary filling and, according to Flynn’s criteria, an excellent recovery of elbow function was observed 3 months postoperatively.ConclusionsThis case demonstrates a rare complication of postoperative artery entrapment with inconspicuous preoperative neurovascular examination. It strongly emphasizes the need for a standardized postoperative neurovascular assessment with fully flexed as well as fully extended elbow.

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Section: Discussionmentioning

confidence: 99%

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

et al. 2017

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“…Permanente sekveler etter karskader ved suprakondylaere humerusfrakturer er likevel en sjeldenhet i dag. I perioden 2001-07 mottok Rikshospitalet kun fem barn med sirkulasjonssvikt etter suprakondylaere humerusfrakturer som var blitt behandlet ved andre sykehus med lukket reposisjon og pinning (32). Disse ble eksplorert og a. brachialis ble funnet interponert i frakturen hos alle.…”

Section: Volkmanns Iskemiunclassified

“…Dersom ekstremiteten er pulsløs, skal man forsøke lukket reponering og perkutan pinning så raskt som mulig (34). Fravaeret av puls kan skyldes trombose, karskade, aneurisme eller at a. brachialis er skadet eller fastklemt i bruddet (32,(35)(36)(37), men skyldes som regel karspasme (38). I de aller fleste tilfellene vil pulsen komme tilbake når bruddet reponeres (fig 3).…”

Section: Volkmanns Iskemiunclassified

“…Noen forfattere anbefaler å eksplorere fossa cubitalis dersom ekstremiteten forblir pulsløs etter reponering og pinning av frakturen (35). Reigstad og medarbeidere anbefaler eksplorering av arterien i alle tilfeller der ekstremiteten forblir pulsløs også etter rereponering av frakturen (32). Behovet for eksplorering av en pulsløs, kald og hvit ekstremitet er åpenbar, mens det er noe diskusjon vedrørende håndteringen av en pulsløs, men varm og rosa hånd (39).…”

Section: Volkmanns Iskemiunclassified

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Suprakondylære humerusfrakturer hos barn

Randsborg

Sivertsen²

2011

Tidsskriftet

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“…Various treatments such as observation,2) arteriography,3,4) magnetic resonance angiography,4) emergent exploration5-8) and delayed exploration9) have been suggested following fracture stabilization.…”

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confidence: 99%

Pulse Oximetry for the Diagnosis and Prediction for Surgical Exploration in the Pulseless Perfused Hand as a Result of Supracondylar Fractures of the Distal Humerus

2013

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BackgroundThe management of the pulseless perfused hand in association with a supracondylar humerus fracture following operative stabilisation remains controversial. Previous authors have suggested the use of color-flow duplex monitoring, magnetic resonance angiography and segmental pressure monitoring as objective steps to ascertain blood flow following adequate internal fixation. We examine the use of the waveform of the pulse oximeter in objectively determining a perfused limb and in predicting the need for surgical exploration in patients who present with a pulseless perfused hand after operative stabilisation for supracondylar fracture of the humerus.MethodsA retrospective review of all supracondylar fractures over a 60 month duration (2005-2009) in our instituition was performed. Each electronic record was reviewed and limbs which had absent radial pulse following admission were identified. X-ray films of each of the patients were reviewed. A search using the Pubmed database was performed with the following keywords, supracondylar humerus fracture, pediatric, pulseless, vascular injury, arterial repair.ResultsIn this series of pulseless perfused hands following operative fixation of supracondylar fracture, a total of 26 patients were reviewed. All were Gartland grade III extension type fractures. Postoperative pulse oximeter waveforms were present in all but 4 patients. These patients subsequently had exploration of the brachial artery with significant findings. In the remaining 22 patients, waveforms were present and the child had return of the radial pulse soon after operative fixation without any further need for surgical exploration. At 24 months follow-up, all children were well with no neurovascular compromise.ConclusionsThe presence of a waveform on a pulse oximeter is a sensitive and easily available modality in determining vascular perfusion as compared to other more complex investigations. The high sensitivity of this test will allow surgeons to objectively determine the requirement for surgical exploration of the brachial artery.

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Supracondylar Fractures With Circulatory Failure After Reduction, Pinning, and Entrapment of the Brachial Artery: Excellent Results More Than 1 Year After Open Exploration and Revascularization

Cited by 22 publications

References 24 publications

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

Suprakondylære humerusfrakturer hos barn

Pulse Oximetry for the Diagnosis and Prediction for Surgical Exploration in the Pulseless Perfused Hand as a Result of Supracondylar Fractures of the Distal Humerus

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