Conservative Treatment in Children with Vascular Injury in Supracondylar Humerus Fractures: a Clinical Trial

Abstract

Introduction

Supracondylar humorous fracture is one of the most important and common fractures in children of 3-10 years old. In this fracture, there is a risk of Injury to the brachial artery, which is considered as an emergency surgery situation in children. The aim of this study was to provide a clinical approach in the treatment of children with supracondylar humorous fractures with coexisting vascular injury and to investigate the effect of conservative treatment in pink pulseless hand with good blood perfusion.

Method

During a clinical trial, a group of children with complaint of extension-type supraclavicular humorous fracture following a blunt trauma were investigated. Investigation was performed following the admission of these children in the emergency room of Trauma Center of Shahid Rajaee Hospital, Qazvin University of Medical Sciences, Iran between 1392/01/01 until 1397/06/01. The maximum age for inclusion in the study was 10 years. In all patients, the perfusion and circulatory condition of damaged organ were carefully examined by checking the capillary refill and radial pulse in the emergency room.
All patients underwent fracture reduction during the first 24 hours after admission. Radial pulse was evaluated during and after the reduction in the emergency room. Patients were under observation up to two weeks after the reduction.

Findings

Out of 26 patients, 17 patients (65.4%) were male and 9 patients (34.6%) were female. The average age was 5 years. Six patients (23.1%) had radial pulse on admission, and 20 patients (76.9%) did not have radial pulse on admission. Average interval between injury and admission to hospital was 4.57 hours. 16 patients (61.5%) underwent open reduction and 10 patients (38.5%) underwent closed reduction. Radial pulse returned immediately after the reduction in 6 patients (23.1%). In all patients, radial pulse was checked during two weeks after the reduction. Vascular refill status on admission was poor in 7 patients (26.9%) and good in 19 patients (73.1%). After the reduction, the capillary refill was good in all patients.

Conclusion

The results of our study demonstrated that there is no need for surgical exploration of artery in treating of pink pulseless arms with sufficient blood perfusion. After a closed reduction, radial pulse will be detected and collateral vessels will maintain the vital function of the organ and therefore arterial surgical exploration imposes complications and unnecessary cost and time.