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Vascular compromise associated with supracondylar fractures in children
H M Rabee1, M M Al-Salman, K Iqbal
1Division of Vascular Surgery, Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. hmrabee@ksu.edu.sa
Insights
Persistently absent radial pulse after humerus fracture reduction indicates vascular compromise. Early brachial artery exploration is crucial in children to prevent limb complications.
Area of Science:
- Pediatric Orthopedics
- Vascular Surgery
- Trauma Management
Background:
- Displaced supracondylar fractures of the humerus in children often present with vascular compromise.
- Assessing the severity of vascular injury is critical for timely intervention.
Purpose of the Study:
- To evaluate the significance of a persistently absent radial pulse and monophasic Doppler flow after closed reduction percutaneous pinning (CRPP) of humerus fractures.
- To determine the necessity of early brachial artery exploration in such cases.
Main Methods:
- Retrospective analysis of 86 children with Grade III supracondylar humerus fractures treated with CRPP.
- Vascular status assessment, including radial pulse and Doppler flow, before and after CRPP.
- Surgical exploration of the brachial artery for cases with persistently absent pulse and monophasic flow.
Main Results:
- Six out of 86 children had persistently absent radial pulse and monophasic Doppler signals post-CRPP.
- All 6 underwent brachial artery exploration, revealing artery entrapment at the fracture site.
- Release of the entrapped artery resulted in immediate return of radial pulse with triphasic Doppler flow.
Conclusions:
- A persistently absent radial pulse, confirmed by absent or monophasic Doppler flow, reliably indicates vascular compromise in pediatric humerus fractures.
- Early surgical exploration of the brachial artery is recommended to prevent pulseless limb complications in children with displaced supracondylar humerus fractures.
Objective:
Our aim was to study the significance of persistently absent radial pulse, with monophasic doppler flow after close reduction percutaneous pinning of displaced supracondylar fracture of humerus, and the need of early exploration of brachial artery in such cases.
Methods:
Between July 1992 and 1999, 86 children with Grade III supracondylar fracture of humerus were treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia The history, physical examination, vascular status of limb before and after close reduction percutaneous pinning of fracture were recorded. All children having persistently absent radial pulse and monophasic flow doppler signals after close reduction percutaneous pinning under went exploration of brachial artery.
Results:
Of the 86 children with Grade III supracondylar fracture of humerus, 6 had persistently absent radial pulse with monophasic flow doppler signals after close reduction percutaneous pinning. Five children had one warm pink well perfused hand and one cold pale poorly perfused hand. All 6 under went exploration of brachial artery and were found to have entrapped artery at the fracture site. There was an immediate return of radial pulse with triphasic Doppler flow on release of brachial artery.
Conclusion:
Persistently absent radial pulse with objectivity, obtained by doppler ultrasound in the form of absent or monophasic flow in radial artery, is a reliable indicator of vascular compromise. Surgical exploration of brachial artery by a competent surgeon is to be carried out to avoid early and late complication, of pulseless limb in children with displaced supracondylar fracture of humerus.
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