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Blunt brachial arterial injury in pediatric patients

Muhammad-Saad Hafeez1, David M Notrica2, Claudie Sheahan3

  • 1Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Journal of Pediatric Surgery
|June 3, 2025
PubMed

Insights

Blunt brachial arterial injury (BBAI) is common in children and can cause limb complications. Management varies, with ongoing debate on treating a pink pulseless hand after BBAI.

Area of Science:

  • Vascular Surgery
  • Pediatric Trauma
  • Emergency Medicine

Background:

  • Blunt brachial arterial injury (BBAI) is the most frequent vascular trauma in pediatric patients.
  • Clinical presentation of BBAI varies based on occlusion severity and collateral circulation.
  • Current treatment strategies range from conservative management to surgical revascularization.

Purpose of the Study:

  • To review the current literature on blunt brachial arterial injury in pediatric patients.
  • To summarize the pathophysiology, clinical presentation, diagnosis, and management of BBAI.
  • To address the controversy surrounding the treatment algorithm for a "pink pulseless hand" secondary to BBAI.

Main Methods:

  • Comprehensive literature review of studies on pediatric blunt brachial arterial injury.
  • Analysis of existing data on BBAI pathophysiology, clinical findings, diagnostic approaches, and treatment outcomes.
  • Synthesis of information to provide an overview of current management strategies.

Main Results:

  • BBAI presents a spectrum of clinical signs and symptoms in the affected extremity.
  • Treatment decisions for BBAI are influenced by the degree of ischemia and surgeon specialty.
  • Controversy persists regarding the optimal management of a "pink pulseless hand" following BBAI.

Conclusions:

  • Effective management of pediatric BBAI requires careful consideration of injury severity and patient factors.
  • Further research and consensus are needed to standardize treatment protocols for specific BBAI presentations, such as the "pink pulseless hand".
  • This review provides a summary of current knowledge to guide clinicians in managing pediatric BBAI.

Keywords:
Blunt brachial artery injuryBrachial artery repairPediatric traumaPediatric vascular injuryPediatric vascular traumaSupracondylar subluxationUpper extremity fracture

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