MANAGEMENT OF PULSELESS HAND IN CHILDREN FOLLOWING CLOSED SUPRACONDYLAR FRACTURE HUMERUS - BEFORE FRACTURE REDUCTION A CASE SERIES

Closed supracondylar humerus fracture in children with pulseless hand though appear to have vascularity even after skeletal stabilisation may need surgical exploration for addressing vascular injury which is often accomplished by thrombectomy , primary repair or interposition graft repair. Between August 2017 and june 2018, 15 children presented with displaced closed supracondylar fracture of the humerus , 10 of them presented with absent radial and ulnar pulses treated either before or after fracture reduction based on the clinical examination findings and hand doppler assessment . Amongst these, seven patients were explored for vascular compromise even after fracture reduction and ended up in revascularisation by thrombectomy or interposition graft repair . Three patients were explored before fracture reduction , one was found to have entrapment of the brachial artery between the fracture fragments and two of them were found to have spasm of the brachial artery by the tractional force from the displaced fracture. surgical exploration before fracture reduction in all these three patients ended up in release of the brachial artery from the tractional force or from entrapped fracture fragment, resulted in distal pulse restoration and thereby avoided thrombectomy or graft repair in the growing children. children presenting with closed supracondylar humerus fracture with absent distal pulses with warm hand need high index of suspicion for exploration before fracture reduction to avoid fracture reduction manipulation associated vascular injury and thereby avoid thrombectomy and graft repair in the growing children.