Arterial Injuries in Children with Supracondylar Fracture of the Humerus - Our Institutional Experience

Objective: To share our experience regarding the management of arterial injuries in children with pulseless hand secondary to supracondylar fracture of the humerus (SFH). Patients and Methods: All consecutive children with pulseless hands after SFH who were being treated in the cardiothoracic and vascular surgery department, Andhra Medical College, Visakhapatnam during the year 2016-2021 were included. The type of fracture, mode and pattern of injury, time from injury to definitive treatment, operative treatment, and complications were recorded. Results: There were 55 [82% (n=45) male and 18% (n=10) female] patients with pulseless hand and SFH [Gartland type III: 18% (n=10) and IV: 82% (n=45)]. The hand was cold in 38.1% (n=21) patients and warm in 61.8% (n=34). The most common mode of injury was accidental fall [45% (n=25)], and the mean time from injury to presentation was 4?2.5 hours (mean?standard deviation). Overall, 71% (n=39) patients underwent vascular reconstruction: autologous interposition venous grafting was performed in 49% (n=19) and segmental resection and primary anastomosis in 25% (n=10) of the cases. There were no cases with amputation, fasciotomy, re-exploration, or long-term ischemic sequel. Conclusion: Immediate vascular exploration is the treatment of choice for cold, pulseless hand. A similar approach should be adopted for warm, pulseless hand if there is no immediate return of pulse.