title: Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report.
abstract: BACKGROUND
  Severely displaced supracondylar fractures of the humerus in children are frequently associated with complications including neurovascular injuries, non-union, or compartment syndrome. In the current literature, no report exists about postoperative brachial artery entrapment in combination with an inconspicuous preoperative neurovascular examination.
  
  
  METHODS
  We present a case of a 6-year-old white boy with a pulseless radial and ulnar artery after open reduction and internal fixation of a severely displaced supracondylar fracture of his right humerus (Gartland type III) using four K-wires. Remarkably, the preoperative neurovascular examination was inconspicuous. Doppler ultrasound of his brachial artery revealed no pulse when his elbow was in flexion and a faint pulse when it was in full extension 10 hours postoperatively. Revision surgery was performed immediately. On intraoperative examination, a kinking of his brachial artery caused by an entrapment of the tunica externa in the reduced fracture was seen and the artery was released by microsurgical arteriolysis immediately. At the final follow-up examination, positive palpable pulse with good capillary filling and, according to Flynn's criteria, an excellent recovery of elbow function was observed 3 months postoperatively.
  
  
  CONCLUSIONS
  This case demonstrates a rare complication of postoperative artery entrapment with inconspicuous preoperative neurovascular examination. It strongly emphasizes the need for a standardized postoperative neurovascular assessment with fully flexed as well as fully extended elbow.
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany. David.Latz@med.uni-duesseldorf.de.
authors.forename: David
authors.initials: D
authors.lastname: Latz
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Grassmann
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Schiffner
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Gehrmann
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Mansur
authors.initials: M
authors.lastname: Duran
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jungbluth
mesh_terms: D001132:Arm / Q000098:blood supply*; D001916:Brachial Artery; D002648:Child; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000209:etiology*
keywords: Case report; Entrapment of the brachial artery; Gartland type III; Neurovascular complications; Open K-wire fixation; Pediatric supracondylar fracture of the humerus