title: The impact of arterial vessel injuries associated with pediatric supracondylar humeral fractures.
abstract: BACKGROUND
  Pediatric supracondylar humeral fractures are regularly complicated by vascular compromise. However, the treatment regimen for pulseless hands with good capillary refill time is discussed controversially. The aim of the present study was to present our treatment strategy in a series of children sustaining supracondylar humeral fractures associated with impaired peripheral blood flow.
  
  
  METHODS
  Medical charts of all children sustaining supracondylar humeral fractures treated between 1995 and 2009 were reviewed. Treatment and the course of patients with impaired peripheral blood flow were evaluated. Patients were invited for a follow-up examination.
  
  
  RESULTS
  Forty of 499 patients sustaining a supracondylar humeral fracture presented with peripheral pulselessness. Two children underwent immediate vascular surgery. In the remaining 38 patients, the fracture was reduced, followed by a re-evaluation of the peripheral circulation. Twenty-four of those patients had normal peripheral pulse and capillary refill time, and no further therapy was necessary. Fourteen patients had a persisting absent peripheral pulse after fracture reduction. While in 4 of those patients-including 3 patients with prolonged peripheral capillary refill time-vascular surgery was performed, 10 patients were successfully treated with "watchful waiting." At follow-up of 3.5 years (range, 2-6 years), the performed diagnostic workup including capillary refill time and blood pressure was without pathologic findings in all patients.
  
  
  CONCLUSIONS
  Our data suggest that blood flow often recovers following reduction of supracondylar fractures with impaired peripheral vascularization. In cases of a "pink pulseless hand" (absent peripheral pulse and good peripheral capillary refill time), "watchful waiting" instead of immediate surgical exploration might be a treatment option. However, further studies with more patients have to be conducted to formulate a recommendation for the treatment of these severe injuries.
  
  
  METHODS
  Therapeutic study, level V.
authors: From the Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors: Helmut
authors: H
authors: Wegmann
authors: Robert
authors: R
authors: Eberl
authors: Tanja
authors: T
authors: Kraus
authors: Holger
authors: H
authors: Till
authors: Christian
authors: C
authors: Eder
authors: Georg
authors: G
authors: Singer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005542:Forearm / Q000098:blood supply; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014680:Veins / Q000293:injuries* / Q000473:pathology / Q000601:surgery