title: Management of the pulseless pediatric supracondylar humeral fracture.
abstract: A pediatric supracondylar humeral fracture with a pulseless, poorly perfused hand requires emergency operative reduction. If the limb remains pulseless and poorly perfused after fracture fixation, vascular exploration and possible reconstruction is necessary. A pediatric supracondylar humeral fracture with a pulseless, well-perfused hand should be treated urgently with operative fixation of the fracture and subsequent reassessment of the vascular status. Controversy exists regarding the optimal management of pediatric supracondylar humeral fractures with a pulseless, well-perfused hand following anatomic reduction and fixation. Options include immediate vascular exploration or twenty-four to forty-eight hours of inpatient observation. If perfusion is compromised during this period of observation, an emergency return to the operating room for vascular exploration and possible reconstruction is indicated.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027. E-mail address: Halehbad@gmail.com. E-mail address for P.D. Choi: PChoi@chla.usc.edu. E-mail address for D.L. Skaggs: DSkaggs@chla.usc.edu.
authors.forename: Haleh
authors.initials: H
authors.lastname: Badkoobehi
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027. E-mail address: Halehbad@gmail.com. E-mail address for P.D. Choi: PChoi@chla.usc.edu. E-mail address for D.L. Skaggs: DSkaggs@chla.usc.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA 02115. E-mail address: Donald.Bae@childrens.harvard.edu.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Bae
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027. E-mail address: Halehbad@gmail.com. E-mail address for P.D. Choi: PChoi@chla.usc.edu. E-mail address for D.L. Skaggs: DSkaggs@chla.usc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000792:Angiography / Q000379:methods; D002675:Child, Preschool; D005592:Fracture Fixation / Q000379:methods; D006225:Hand / Q000098:blood supply; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery*; D007103:Immobilization / Q000379:methods; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D010808:Physical Examination / Q000379:methods; D011674:Pulse; D020196:Trauma, Nervous System / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D018608:Ultrasonography, Doppler / Q000379:methods; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*