EVALUATING VASCULAR INTERVENTION STRATEGIES IN PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES WITH PULSELESS HAND: A COMBINED PROSPECTIVE-RETROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.22159/ijcpr.2025v17i2.6060Keywords:
Pediatric supracondylar fracture, Vascular injury, Pink pulseless hand, Brachial artery, Reexploration, Functional outcomeAbstract
Objective: Vascular compromise in pediatric supracondylar humerus fractures (SCHFs) poses a serious threat to limb viability. Controversy persists regarding the necessity and timing of vascular exploration, particularly in “pink pulseless” scenarios. This study evaluated the impact of different vascular management strategies on functional outcomes and the need for reexploration in children with SCHFs and a pulseless hand.
Methods: We conducted a single-center prospective-retrospective study of 25 children under 14 y with Gartland Type II and III SCHFs complicated by vascular compromise. Patients were treated between August 2018 and December 2021. Demographic data, fracture classification, vascular status (pale vs. pink pulseless), and mode of injury were recorded. Management strategies included observation after fracture fixation or immediate vascular exploration (thrombectomy, arterial repair, or venous grafting). Outcomes were assessed by return of radial pulse, need for reexploration, and Mayo Elbow Performance Scores (MEPS).
Results: Of 25 patients, 19 (76%) presented with a pink pulseless hand and 6 (24%) with a pale pulseless hand. Vascular intervention was performed in 60%, while 40% were managed initially without exploration. Radial pulse returned spontaneously in 72% following skeletal stabilization. However, delayed intervention led to a 28% reexploration rate. Patients undergoing timely vascular repair demonstrated significantly better MEPS outcomes (p<0.05) and reduced rates of deformity and complications. No significant association was noted between vascular intervention and the need for fasciotomy.
Conclusion: The decision to perform early vascular exploration in pediatric SCHFs should be guided by clinical presentation and response after bony fixation. Prompt vascular intervention in selected patients improves functional outcomes, reduces the likelihood of reexploration, and enhances overall recovery. These findings support incorporating vascular assessment protocols and early definitive management to optimize limb function and minimize complications.
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