Pediatric supracondylar humerus fractures with pulseless hand. is early brachial artery exploration advised ?

Abstract EN

Objective : To present our experience and evaluate the safety of our approach for the management of children with a pulseless hand secondary to supracondylar fracture of the humerus (SHF).

Methods : A retrospective study was conducted at the vascular surgery department and orthopedic department at King Hussein Medical Center (KHMC).

Pediatric patients that presented to ( KHMC) with (SHF) and a pulseless hand between April 2016 and April 2018 were included in the study.

Data included the patients’ age, sex, time between trauma and presentation, signs of hand ischemia, resumption of pulses after fracture reduction, necessity for surgical exploration, type of vascular injury and intervention, outcomes of the vascular repair, and ischemic sequelae.

Results: 160 patients with SHF were admitted to KHMC during the study, of which 23 had an absent pulse.

The age range of the patients was 3-14 years, (mean 6.3 years, SD 2.87).The time interval between the trauma and presentation to KHMC was 2-25 hours (mean 5.13 hours, SD 4.99).

5 of the 23 patients had signs of hand ischemia, 18 of the 23 had a pulseless but perfused hand.

Overall, 19 of the patients 23 (82.6 %) underwent brachial artery exploration; 5 of 19 (26.32 %) underwent brachial thrombectomy; 6 of 19 (31.58 %) underwent brachial artery mobilization followed by thrombectomy; 5 of 19 (26.32 %) underwent brachial artery repair using saphenous vein graft; and 3 of 19 (15.78 %) underwent stripping of the brachial artery adventitia followed by thrombectomy.

There were no cases of amputation, fasciotomy, re-exploration, or long-term ischemic complications.

Conclusion : Early brachial artery exploration is recommended in padiatric patients with SHF and pulseless hand to prevent limb loss and debilitating long-term ischemic complications.