Vascular injury following supracondylar humerus fractures in children

One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair.DISCUSSION: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ische-mia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

📌 3 Key Takeaways

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Objective & Hypothesis:BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.METHODS: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively.

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Key Findings & Data:The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.RESULTS: In 27 patients, radial pulse was palpated following reduction.

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Conclusion & Impact:One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair.DISCUSSION: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ische-mia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Domain Parameters

Abstract

BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.METHODS: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.RESULTS: In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair.DISCUSSION: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ische-mia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Özet

AMAÇ: Çocuk suprakondiller humerus kırığı sonrası ekstremite distalinde nabız alınamayan hastaların sonuçlarını değerlendirmektir.GEREÇ VE YÖNTEM: Suprakondiler humerus kırığı sonrası ekstremite distalinde nabız alınamayan 42 hasta geriye dönük olarak değerlendirildi. Bu hastaların ortalama yaşı 7.3 (dağılım, 5-14 yaş) yıl idi. Hastaların 27'si (%64) erkek 15'i (%36) kızdı. Ameliyat öncesi ve sonrası nörolojik muayene bulguları, yaralanma şekli, yaralanma ile hastaneye başvuru arasında geçen süre ve ameliyata alınma zamanı, hastanede kalma süresi ve ameliyat sonrası görülen komplikasyonlar açısından hastalar değerlendirildi.BULGULAR: Tüm hastalarda Gartland tip 3 kırık mevcuttu. Yirmi yedi hastada redüksiyon sonrası radial nabız palpe edilmeye başlandı. On hastada sadece Doppler ile belirlenen akım mevcut iken, iki hastada akım alınamadı. Dolaşım bozukluğu olmayan bu iki hastada da ameliyattan bir gün sonra Doppler ile akım alınmaya başlandı. Redüksiyon sonrası dolaşım bozukluğu devam eden ve Doppler ultrasonografi ile akım alınamayan diğer üç (%7) hastaya acil vasküler eksplorasyon uygulandı. Bir hastaya primer sütürasyon, diğer iki hastaya ise safen greft ile tamir uygulandı.SONUÇ: Suprakondiller humerus kırığına bağlı nabızsız el gelişen hastalar, redüksiyon sonrası yeniden değerlendirilmeli; ekstremite dolaşımı düzelenler ve dolaşım bozuluğu bulguları olmayanlar için sadece yakın takip, dolaşım bozukluğu devam edenlere ise damar tamiri yapılmalıdır

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Cite This Article

ÖZKUL, E., GEM, M., ALEMDAR, C., ARSLAN, H., AZBOY, İ., ÇELİK, V. (2016). Vascular injury following supracondylar humerus fractures in children. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 22 - Sayı: 1, 84–89. https://ajindex.com/articles/324851

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