title: Pulse oximetry for the diagnosis and prediction for surgical exploration in the pulseless perfused hand as a result of supracondylar fractures of the distal humerus.
abstract: BACKGROUND
  The management of the pulseless perfused hand in association with a supracondylar humerus fracture following operative stabilisation remains controversial. Previous authors have suggested the use of color-flow duplex monitoring, magnetic resonance angiography and segmental pressure monitoring as objective steps to ascertain blood flow following adequate internal fixation. We examine the use of the waveform of the pulse oximeter in objectively determining a perfused limb and in predicting the need for surgical exploration in patients who present with a pulseless perfused hand after operative stabilisation for supracondylar fracture of the humerus.
  
  
  METHODS
  A retrospective review of all supracondylar fractures over a 60 month duration (2005-2009) in our instituition was performed. Each electronic record was reviewed and limbs which had absent radial pulse following admission were identified. X-ray films of each of the patients were reviewed. A search using the Pubmed database was performed with the following keywords, supracondylar humerus fracture, pediatric, pulseless, vascular injury, arterial repair.
  
  
  RESULTS
  In this series of pulseless perfused hands following operative fixation of supracondylar fracture, a total of 26 patients were reviewed. All were Gartland grade III extension type fractures. Postoperative pulse oximeter waveforms were present in all but 4 patients. These patients subsequently had exploration of the brachial artery with significant findings. In the remaining 22 patients, waveforms were present and the child had return of the radial pulse soon after operative fixation without any further need for surgical exploration. At 24 months follow-up, all children were well with no neurovascular compromise.
  
  
  CONCLUSIONS
  The presence of a waveform on a pulse oximeter is a sensitive and easily available modality in determining vascular perfusion as compared to other more complex investigations. The high sensitivity of this test will allow surgeons to objectively determine the requirement for surgical exploration of the brachial artery.
authors: Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore. 　drreuben@hotmail.com
authors: Reuben Chee Cheong
authors: RC
authors: Soh
authors: D Khawn
authors: DK
authors: Tawng
authors: Arjandas
authors: A
authors: Mahadev
mesh_terms: D001916:Brachial Artery / Q000293:injuries* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006225:Hand / Q000098:blood supply*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery*; D008297:Male; D010092:Oximetry; D011674:Pulse; D012189:Retrospective Studies; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000601:surgery
keywords: Pediatric; Pulse oximetry; Pulseless hand; Supracondylar humeral fracture; Vascular repair