Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series
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The management of pulseless supracondylar fractures remains controversial. The aims of this study were to: (1) analyse functional and vascular outcomes of conservative treatment for cases with absent pulse before reduction, whether patients showed limb ischaemia or not; and (2) identify factors associated with vascular complications.
Twenty-seven children with absent pulses on presentation were treated consecutively between 1999 and 2009. The brachial artery was surgically explored in cases of persistent signs of ischaemia after reduction. Signs of vascular impairment were recorded in the early post-operative period and at a mean final follow-up of 3.5 years.
Recurrent ischaemia with a compartment syndrome occurred in a patient with initial ischaemia and a pink, pulseless hand after reduction. Patients with an initially well-perfused hand and those with pre-operative ischaemia and palpable pulses after reduction had satisfactory outcomes, as did patients with early arterial exploration. No patient showed signs of chronic vascular impairment. The need for vascular repair was significantly correlated with open fracture, initial ischaemia and nerve impairment.
Conservative management of supracondylar fractures with absent pulses avoided long-term vascular complications provided that patients with a pulseless, well-perfused hand on presentation were closely monitored after reduction. Further study is necessary to determine whether a forearm Doppler would help identify children with absent pulses after reduction who need surgical revascularisation due to an insufficient collateral circulation.
KeywordsFracture Supracondylar Humerus Children Compartment syndrome Volkmann contracture Ischemia
Compliance with ethical standards
Conflict of interest
Cambon-Binder, Jehanno, Tribout and Simon declare that they have no conflict of interest.
Valenti reports personal fees from FH Orthopedics, and does consulting for Arthrex, Biomet and Zimmer, not related to the submitted work.
Mazda reports being consultant for Implanet, not related to the submitted work.
Ilharreborde reports being a consultant for EOS Imaging, Implanet, Medtronics, and Zimmer Spine, not related to the submitted work.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Ethical review committee
Our local institutional ethical review committee, le Comité d’Evaluation de l’Ethique des Projets de Recherche de Robert Debré, approved the study (Letter N° 2016/299 (2)).
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