title: Management of acute 'pink pulseless' hand in pediatric supracondylar fractures of the humerus.
abstract: The management of a persistent pink pulseless hand after a satisfactory closed reduction in a pediatric supracondylar fracture of the humerus is controversial. Several recent publications have recommended vascular exploration in contrast to a more conservative approach accepted traditionally. We report the results of seven patients with a mean follow-up of 36.6 months with a persistent pulseless, but well-perfused hand postreduction. All patients were managed conservatively without vascular exploration. A palpable return of the radial pulse was seen in six patients at 3 weeks and at 6 weeks follow-up in the other patient with no long-term dysfunction. We believe that the management of a persistent pink pulseless hand remains a 'watchful expectancy'. Surgical exploration should be recommended only if there is either severe pain in the forearm persisting for more than 12 h after the injury or if there are signs of a deteriorating neurological function.
authors.affiliation: Department of Orthopaedic Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, Tamil Nadu, India.
authors.forename: Perumal
authors.initials: P
authors.lastname: Ramesh
authors.forename: Ashwin
authors.initials: A
authors.lastname: Avadhani
authors.forename: Ajoy Prasad
authors.initials: AP
authors.lastname: Shetty
authors.forename: Jayaramaraju
authors.initials: J
authors.lastname: Dheenadhayalan
authors.forename: S
authors.initials: S
authors.lastname: Rajasekaran
mesh_terms: D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006225:Hand / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D011674:Pulse; D012189:Retrospective Studies; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D057832:Watchful Waiting