Management of pulseless pink hand in pediatric supracondylar fractures of humerus.
Thirteen (3.2%) of 410 patients seen in British Columbia's Children's Hospital in Vancouver from January 1984 to September 1992 with supracondylar fractures did so with an absence of a radial pulse in an otherwise well perfused hand. A combination of segmental pressure monitoring, color-flow duplex scanning, and magnetic resonance angiography (MRA) appears to be a valid, noninvasive, and safe technique in evaluating patency of the brachial artery and collateral circulation across the elbow. Based on this study, early revascularization of a pulseless otherwise well-perfused hand in children with type 3 supracondylar fractures, although technically feasible and safe, has a high rate of asymptomatic reocclusion and residual stenoses of the brachial artery. Therefore a period of close observation with frequent neurovascular checks should be completed before more invasive correction of this problem is contemplated.
Sabharwal
S
S
British Columbia's Children's Hospital, Vancouver, Canada.
Tredwell
S J
SJ
Beauchamp
R D
RD
Mackenzie
W G
WG
Jakubec
D M
DM
Cairns
R
R
LeBlanc
J G
JG
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D006225:Hand / Q000098:blood supply*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications*; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D009460:Neurologic Examination; D011674:Pulse; D015203:Reproducibility of Results; D017131:Thrombectomy; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency