Treatment of supracondylar fracture of the humerus in children by skeletal traction in a brace

Michael, A.

doi:10.1302/0301-620x.87b3.0870434

Cited by 2 publications

(3 citation statements)

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“…A supracondylar fracture requires an orthopedic consultation for the determination of appropriate intervention. Most pediatric orthopedists recommend closed reduction and percutaneous pin fixation [ 11 – 14 ]. Because supracondylar fractures of the humerus in children should be considered a surgical emergency, the immediacy of admission to a clinic is of the prime importance.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children

Matuszewski

2013

Eur J Orthop Surg Traumatol

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Elbow region fractures are the most common injuries in children. Among them, supracondylar fractures of the humerus are the most frequent. Massive displacement of the fractured bone causes severe injury to the soft tissue of that particular region. As a result, various types of injuries to the brachial artery such as entrapment, laceration, spasm of the vessel, and the presence of an intimal tear or thrombus formation are usually observed. The main goal of this study was to present our approach to children with supracondylar humerus fractures associated with brachial artery injuries. We would especially like to emphasize the necessity for other conservative or operative treatment concerning pulseless hand symptoms coexisting with supracondylar fractures of the humeral bone in children population. Data from 67 children were evaluated in our study. Supracondylar fractures were classified according to the Gartland’s scale. All patients had displaced extension type III injuries. During our follow-up study, we used Flynn’s grading system to evaluate functions of the elbow joint, forearm and wrist. Mean follow-up was 18 months; range, 13 months to 4 years. In the follow-up study, very good or good results were achieved in all 32 patients treated conservatively together with 6 patients with pulseless pink hand symptom. Very good or good results were achieved in 88 % of 35 patients operated on. Children who, after satisfactory closed reduction, have a well-perfused hand but absent radial pulse do not necessarily require routine exploration of the brachial artery. Conservative treatment should be applied unless additional signs of vascular compromise appear. Thus, exploration of the cubital fossa should be performed only if circulation is not restored by closed reduction.

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Section: Discussionmentioning

confidence: 99%

“…Nowadays complications are very rare and mainly caused by a delay time of surgical intervention [ 11 , 23 , 24 ]. However, opinions vary on a detailed diagnosis and treatment of vascular compromise in cases where the hand remains pulseless but well perfused [ 3 , 8 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children

Matuszewski

2013

Eur J Orthop Surg Traumatol

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“…That is, generally speaking, a permanent flexion contracture of fingers, hand and wrist due to post traumatic blood flow disturbances. Basic treatment for type III of supracondylar fractures that is recommended by most pediatric orthopedists is closed reduction in steps as follows: axial traction of the limb, reduction maneuver and percutaneous crosspinning [7,8]. In case of perfusion disturbances manifesting by "pulseless pale hand" surgical exploration is needed for restoration of brachial artery.…”

Section: Introductionmentioning

confidence: 99%

Oxygen saturation measurement in dislocated supracondylar fractures in children

Matuszewski¹,

Budkowski²,

Lach³

et al. 2019

Chir. Narzadow Ruchu Ortop. Pol.

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The goal of his study was to show that oxygen saturation measurement in the distal part of injured upper extremity is one of the best method to assess post-traumatic blood flow disturbances and the necessity for exploration of brachial artery in supracondylar fractures. 32 children, age 4-16, with Gartland's displaced extension type III injuries and distal disruption of blood flow were treated between 2014 and 2018. Blood disturbances were measured by pulse oximeter. Very good or good results were achieved in 22 non-operatively treated patients where pulseless pink hand symptoms occurred and, after reduction, disappeared. Very good or good results were achieved in 9 patients with pulseless pale and cold hand symptoms. In one patient with pulseless hand (verified by pulse oximeter) but without symptoms of cold hand we decided to explore brachial artery after angio CT examination (Angio-CT showed complete entrapment of the brachial artery). In conclusion we think that oxygen saturation measurement in dislocated supracondylar fractures in children is the best method. It allows us determine whether to avoid or to perform exploration of brachial artery. It is also easily accessible in comparison to the Doppler US or other imaging tools.

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Treatment of supracondylar fracture of the humerus in children by skeletal traction in a brace

Cited by 2 publications

References 1 publication

Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children

Evaluation and management of pulseless pink/pale hand syndrome coexisting with supracondylar fractures of the humerus in children

Oxygen saturation measurement in dislocated supracondylar fractures in children

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