The Pulseless Supracondylar Humerus Fracture: To Explore or Not

Supracondylar humerus fractures are the most common elbow fracture requiring surgical intervention in the pediatric population; therefore, any orthopaedic surgeon who treats pediatric orthopaedic trauma patients must be well versed in the appropriate evaluation and treatment of supracondylar fractures. It is important to focus on a subset of pediatric supracondylar humerus fractures in which the patient has an associated loss of a palpable radial pulse, termed the pulseless supracondylar. Essential considerations for these injuries include the initial evaluation and care in the emergency department setting, facility resources needed for the broad range of potential definitive care, the recommended timing of treatment, the approaches and indications for closed and open surgical intervention, and recommendations for postoperative management. Specific attention should be given to the recommended treatment algorithm for closed fractures with vascular compromise, covering scenarios when open exploration is not recommended, when it should be considered, and in clinical scenarios when it is clearly indicated.