Brachial artery injuries in children

Area of Science:

• Pediatric vascular surgery
• Pediatric trauma surgery
• Orthopedic trauma

Background:

• Brachial artery injuries in children, often linked to supracondylar humeral fractures, present a diagnostic challenge when distal pulses are absent but the hand remains perfused.
• The management of these pulseless, yet pink, hands is debated, particularly concerning the necessity of surgical intervention.

Observation:

• A retrospective study reviewed eight pediatric patients (ages 3-13) with absent distal pulses after arm trauma, all undergoing brachial artery exploration.
• Four patients presented with cold, devascularized hands due to dislocations, fractures, or dog bites, necessitating revascularization.
• The remaining four patients had pulseless, pink hands secondary to type III supracondylar humerus fractures, involving brachial artery thrombosis or tethering.

Findings:

• Surgical exploration confirmed brachial artery obstruction or severance in all eight children.
• Brachial artery revascularization was successfully performed in all cases, restoring distal pulses without vascular complications.
• The study highlights that absent pulses, regardless of hand perfusion, indicate compromised blood flow requiring intervention.

Implications:

• The findings support the indication for surgical exploration of the brachial artery in pediatric patients with absent distal pulses following trauma.
• Early surgical intervention can prevent severe complications and ensure adequate limb perfusion in pediatric brachial artery injuries.
• This study contributes to the understanding and management guidelines for pediatric brachial artery trauma, emphasizing prompt diagnosis and treatment.