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Vascular examination predicts functional outcomes in supracondylar humerus fractures: a prospective study
Justin J Ernat1, Robert L Wimberly2, Christine A Ho2
1Blanchfield Army Community Hospital, Fort Campbell, Kentucky, USA.
Insights
Children with abnormal vascular exams after supracondylar humerus fractures (SCHFX) have poorer functional outcomes. A palpable pulse, indicating normal vascularity, predicts better pain relief and upper extremity function post-surgery.
Area of Science:
- Pediatric Orthopedics
- Vascular Surgery
- Musculoskeletal Research
Background:
- Supracondylar humerus fractures (SCHFX) are common in children.
- Vascular insult is a significant complication of SCHFX, potentially impacting long-term function.
- Validated outcome measures are crucial for assessing the impact of vascular complications.
Purpose of the Study:
- To prospectively evaluate functional outcomes in pediatric patients with SCHFX and associated vascular insult.
- To determine the relationship between vascular examination findings and functional outcome measures.
Main Methods:
- Prospective enrollment of operative SCHFX patients over three years.
- Assessment of radial pulse, Doppler studies for non-palpable pulses, and hand perfusion.
- Utilized Pediatric Outcomes Data Collection Instruments (PODCI) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) for functional assessment.
Main Results:
- 146 patients completed follow-up; 20% had abnormal vascular exams (asymmetric or non-palpable pulses).
- Patients with symmetric, palpable pulses showed significantly better PODCI pain/comfort and QuickDASH scores.
- Palpable pulses, irrespective of symmetry, correlated with superior PODCI pain and comfort scores compared to non-palpable pulses.
Conclusions:
- Abnormal vascular examination in pediatric SCHFX predicts worse pain and upper extremity function.
- The presence of a palpable pulse is a positive predictor of better pain and comfort outcomes.
Purpose:
This article prospectively examines the functional outcome measures following management of vascular insult secondary to paediatric supracondylar humerus fractures (SCHFX) using validated outcome measures.
Methods:
The three-year, prospective, IRB-approved study consecutively enrolled operative SCHFX patients. Clinical data included presence and symmetry of the radial pulse in injured and uninjured extremities, Doppler examination of non-palpable (NP) pulses and perfusion status of the hand. Pediatric Outcomes Data Collection Instruments (PODCI) and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Measures were used to assess functional outcome at final follow-up. Multiple regression analysis was used to determine the relationship between the presence of a vascular abnormality and functional outcome while controlling for other injury parameters.
Results:
A total of 146/752 enrolled patients (mean age 6.8 years; range 2 years to 13 years) completed functional outcome measures at final follow-up. Of these, 20 (14%) patients had abnormal vascular exams at presentation: nine (6%) with palpable asymmetric pulse and 11 (7.5%) with NP pulse. Of those with NP pulses, nine/11 (6%) were Dopplerable and two (1.5%) lacked identifiable Doppler signal. Patients with a symmetric, palpable pulse demonstrated better PODCI pain and comfort scores (95.2 versus 85.2) (p < 0.0001), and QuickDASH scores (10.9 versus 21.6) (p < 0.007) compared to those with any abnormal vascular examination. Patients with palpable pulses, regardless of symmetry, demonstrated significantly higher PODCI pain and comfort scores (94.6 versus 84.7) (p < 0.003) than NP pulses.
Conclusions:
In children with operative SCHFX, an abnormal vascular examination at presentation is predictive of poorer outcomes in pain and upper extremity function. A palpable pulse, versus NP, is predictive of better pain and comfort at final follow-up.
Level Of Evidence:
II.
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