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Pink pulseless hand following supra-condylar fractures: an audit of British practice
Ajay Malviya1, Damon Simmons, Ram Vallamshetla
1Trauma and Orthopaedics Birmingham Children's Hospital, Birmingham, UK. malviya7@aol.com
Insights
Paediatric orthopaedic surgeons in the UK manage uncomplicated elbow fractures promptly. For
Area of Science:
- Paediatric Orthopaedics
- Surgical Management
- Fracture Care
Background:
- Displaced supracondylar fractures are common in children.
- The 'pink pulseless hand' complication requires careful management decisions.
Purpose of the Study:
- To establish a consensus on managing displaced supracondylar fractures in children.
- To address the specific challenges of the 'pink pulseless hand' scenario.
Main Methods:
- A postal questionnaire survey was distributed.
- Members of the British Society for Children's Orthopaedic Surgery were targeted.
Main Results:
- Most UK paediatric orthopaedic surgeons treat uncomplicated fractures urgently, before midnight.
- Stabilization is considered even after midnight if a radial pulse is absent.
- Observation is preferred over aggressive treatment for a pulseless but perfused hand post-stabilization.
Conclusions:
- There is a consensus on timely management of uncomplicated fractures.
- Management of 'pink pulseless hand' prioritizes stabilization and observation if perfusion is maintained.
Abstract:
A postal questionnaire was sent to the members of the British Society for Children's Orthopaedic Surgery to form a consensus on the management of displaced supra-condylar fractures especially when complicated by a 'pink pulseless hand'. A majority of the paediatric orthopaedic practitioners in the United Kingdom would deal with the uncomplicated supra-condylar fractures as soon as possible but not after midnight. In the absence of a radial pulse, stabilization would be considered even after midnight. If the hand remains pulseless but well perfused after stabilization the preferred option would be to observe and rely on collateral circulation rather than treating it more aggressively.
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