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International Orthopaedics
Published in: International Orthopaedics 4/2018

01-04-2018 | Original Paper

Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series

Authors: Adeline Cambon-Binder, Pascal Jehanno, Laurent Tribout, Philippe Valenti, Anne-Laure Simon, Brice Ilharreborde, Keyvan Mazda

Published in: International Orthopaedics | Issue 4/2018

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Abstract

Purpose

The management of pulseless supracondylar fractures remains controversial. The aims of this study were to: (1) analyse functional and vascular outcomes of conservative treatment for cases with absent pulse before reduction, whether patients showed limb ischaemia or not; and (2) identify factors associated with vascular complications.

Methods

Twenty-seven children with absent pulses on presentation were treated consecutively between 1999 and 2009. The brachial artery was surgically explored in cases of persistent signs of ischaemia after reduction. Signs of vascular impairment were recorded in the early post-operative period and at a mean final follow-up of 3.5 years.

Results

Recurrent ischaemia with a compartment syndrome occurred in a patient with initial ischaemia and a pink, pulseless hand after reduction. Patients with an initially well-perfused hand and those with pre-operative ischaemia and palpable pulses after reduction had satisfactory outcomes, as did patients with early arterial exploration. No patient showed signs of chronic vascular impairment. The need for vascular repair was significantly correlated with open fracture, initial ischaemia and nerve impairment.

Conclusions

Conservative management of supracondylar fractures with absent pulses avoided long-term vascular complications provided that patients with a pulseless, well-perfused hand on presentation were closely monitored after reduction. Further study is necessary to determine whether a forearm Doppler would help identify children with absent pulses after reduction who need surgical revascularisation due to an insufficient collateral circulation.
Appendix
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Metadata
Title
Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series
Authors
Adeline Cambon-Binder
Pascal Jehanno
Laurent Tribout
Philippe Valenti
Anne-Laure Simon
Brice Ilharreborde
Keyvan Mazda
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3698-5

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