title: Supracondylar fractures with circulatory failure after reduction, pinning, and entrapment of the brachial artery: excellent results more than 1 year after open exploration and revascularization.
abstract: OBJECTIVE
  Neurovascular injuries in children with dislocated supracondylar humeral fractures are not uncommon. Closed reduction and pin fixation usually will restore the circulation. In some patients, there is still compromised circulation and a neurologic deficit, and they are treated with open exploration and microvascular reconstruction. We have investigated the clinical and functional outcome more than 1 year after the injury in this most serious group of patients.
  
  
  METHODS
  Retrospective follow-up study.
  
  
  METHODS
  During 2001 to 2007, five patients were referred to our department with a pale, pulseless hand and circulatory impairment with absent or slow capillary refill after primary treatment with closed reduction and cross pinning at their local hospital for Gartland Type III supracondylar fractures. Two of the patients also had clinical signs of nerve injury.
  
  
  METHODS
  All were reoperated on with open exploration and release of the entrapped brachial artery. Vascular reconstruction was performed in four patients (vasodilating agent was sufficient in one patient) and release of the median nerve from the fracture in two. One of these two also had a Kirschner wire pierced through the ulnar nerve. All fractures were rereduced and cross-pinned. No intra- or postoperative complications were seen. OUTCOME/RESULTS: At follow-up more than 1 year after the injury, all patients exhibited normal and symmetric function in their upper extremities, including circulation, neurologic status, range of motion, grip strength, and key pinch strength. Clinical and radiologic appearance was normal.
  
  
  CONCLUSIONS
  Pulseless arms after repositioning of dislocated supracondylar humeral fractures are a medical emergency. After open release and, if necessary, microvascular reconstruction of vessels and nerves, fracture reduction, and fixation, excellent clinical long-term outcome can be expected. The procedure can be carried out with a low rate of complications.
authors.affiliation: Hand and Microsurgery Section, Orthopedic Department, Rikshospitalet, Songsvannsveien 20, Oslo, Norway. ole.reigstad@gmail.com
authors.forename: Ole
authors.initials: O
authors.lastname: Reigstad
authors.forename: Rasmus
authors.initials: R
authors.lastname: Thorkildsen
authors.forename: Christian
authors.initials: C
authors.lastname: Grimsgaard
authors.forename: Astor
authors.initials: A
authors.lastname: Reigstad
authors.forename: Magne
authors.initials: M
authors.lastname: Røkkum
mesh_terms: D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D001858:Bone Nails; D001916:Brachial Artery / Q000293:injuries* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome