Abstract
Introduction: Approximately 5% of grade III supracon-dylar fractures are associated with vascular compromise. Following closed reduction and K wire stabilisation 60% of childrens surgeons in UK would adopt a policy of observation providing the hand is well perfused. We have retrospectively compared 2 groups of patients to determine whether observation or exploration leads to the best outcome.
Materials and Methods: Over a 7 year period 18 patients were identified with pulseless pink hands. Management following reduction and K wire fixation was at the discretion of the admitting consultant. 10 Patients were managed expectantly and 8 patients had immediate exploration of the vessel.
Results: Of 10 patients managed by observation, 3 had secondary exploration of the vessel and one patient has developed forearm claudication. Although a palpable radial pulse was present in all cases by 3 months it had returned within 24hrs (suggesting spasm of the artery) in only 3 patients.
In 6 of 8 primarily explored brachial arteries the vessel was observed to be tethered to the fracture site.
Following release, in 6 of 8 cases the radial pulse had returned within 24hrs. Satisfactory radiological reduction of the fracture does not preclude vessel entrapment.
In 8 cases there was an associated median nerve palsy. All of these cases were found to have an anatomical obstruction to the brachial artery.
Conclusions: In the majority of cases absent pulse is due to vessel entrapment. Long term perfusion of the forearm is due to collateral circulation. Providing a near anatomical reduction is achieved observation for 24 hours would seem reasonable course of action. If the pulse has not then returned further imaging (arte-riograme/MRA) may be advisable. If there is associated nerve palsy immediate exploration is warranted
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
