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DOI: 10.1055/s-0041-1742139
Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children
Funding None.Abstract
Blunt trauma of the brachial artery (BA) in pediatric age is often associated with neurological and orthopaedic injuries. Acute ischemic hands warrant immediate exploration, but the management of warm-pulseless hands following elbow trauma is controversial. This study evaluates the role of conservative treatment of blunt BA injuries in children with non-threatened hands. Eleven children with blunt trauma onto the BA having warm-pulseless hands were studied retrospectively. After a mean follow-up period of 2.5 ± 0.9 years, all cases had thorough clinical examination and duplex scan to assess the treatment outcomes. At the end of follow-up period, all subjects had well-perfused hands with intact wrist pulses. The duplex scan revealed those who had interposition grafts to be patent and one case had an aneurysmal dilatation. There was no statistical significance difference between affected and healthy forearms regarding the mean peak systolic velocity at the wrist, affected side was 62 ± 0.82 cm/s versus 68 ± 0.57 cm/s for opposite side (p-value = 0.14). Patients with blunt BA trauma and warm-pulseless hands could be managed safely with conservative treatment, leaving surgical exploration for those who did not regain pulses after 48 hours. Duplex ultrasound can safely verify the patency of surgical repair and can be used for surveillance to detect future complications.
Keywords
brachial artery - supracondylar fractures - brachial bifurcation - blunt trauma - pediatric age - Doppler flowNote
Presented as an oral presentation at Charing Cross Vascular Symposium on 15 to 18 April 2019, London, UK.
Publication History
Article published online:
05 February 2022
© 2022. International College of Angiology. This article is published by Thieme.
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References
- 1 Cheng JC, Ng BK, Ying SY, Lam PK. A 10-year study of the changes in the pattern and treatment of 6,493 fractures. J Pediatr Orthop 1999; 19 (03) 344-350
- 2 Blakey CM, Biant LC, Birch R. Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood: long-term follow-up. J Bone Joint Surg Br 2009; 91 (11) 1487-1492
- 3 Schoenecker PL, Delgado E, Rotman M, Sicard GA, Capelli AM. Pulseless arm in association with totally displaced supracondylar fracture. J Orthop Trauma 1996; 10 (06) 410-415
- 4 Ramdass MJ, Harnarayan P. Brachial artery reconstruction in trauma using reversed arm vein from the injured upper limb. Plast Reconstr Surg Glob Open 2016; 4 (10) e1034
- 5 Lewis HG, Morrison CM, Kennedy PT, Herbert KJ. Arterial reconstruction using the basilic vein from the zone of injury in pediatric supracondylar humeral fractures: a clinical and radiological series. Plast Reconstr Surg 2003; 111 (03) 1159-1163 , discussion 1164–1166
- 6 White L, Mehlman CT, Crawford AH. Perfused, pulseless, and puzzling: a systematic review of vascular injuries in pediatric supracondylar humerus fractures and results of a POSNA questionnaire. J Pediatr Orthop 2010; 30 (04) 328-335
- 7 Weller A, Garg S, Larson AN. et al. Management of the pediatric pulseless supracondylar humeral fracture: is vascular exploration necessary?. J Bone Joint Surg Am 2013; 95 (21) 1906-1912
- 8 Scannell BP, Jackson III JB, Bray C, Roush TS, Brighton BK, Frick SL. The perfused, pulseless supracondylar humeral fracture: intermediate-term follow-up of vascular status and function. J Bone Joint Surg Am 2013; 95 (21) 1913-1919
- 9 Luria S, Sucar A, Eylon S. et al. Vascular complications of supracondylar humeral fractures in children. J Pediatr Orthop B 2007; 16 (02) 133-143
- 10 Griffin KJ, Walsh SR, Markar S, Tang TY, Boyle JR, Hayes PD. The pink pulseless hand: a review of the literature regarding management of vascular complications of supracondylar humeral fractures in children. Eur J Vasc Endovasc Surg 2008; 36 (06) 697-702
- 11 Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci 2001; 6 (04) 312-315
- 12 Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 1991; 13 (03) 452-458
- 13 Garbuz DS, Leitch K, Wright JG. The treatment of supracondylar fractures in children with an absent radial pulse. J Pediatr Orthop 1996; 16 (05) 594-596
- 14 Shaw BA, Kasser JR, Emans JB, Rand FF. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma 1990; 4 (01) 25-29
- 15 Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1988; 70 (05) 641-650
- 16 Sabharwal S, Tredwell SJ, Beauchamp RD. et al. Management of pulseless pink hand in pediatric supracondylar fractures of humerus. J Pediatr Orthop 1997; 17 (03) 303-310
- 17 Copley LA, Dormans JP, Davidson RS. Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention. J Pediatr Orthop 1996; 16 (01) 99-103
- 18 Bergman RA, Thompson SA, Afifi AK. Catalogue of Human Variation. Baltimore, MD: Urban and Schwartzenberg; 1984: 108