Vascular injuries in supracondylar humeral fracture: An active approach to diagnosis and treatment

Aim: The strategy with vascular complications of supracondylar humeral fractures (SHF) is under scrutiny since modern diagnostic techniques, particularly ultrasound investigations, provide earlier and more precise assessment and updated vascular surgical procedures, particularly microvascular ones, obtain excellent results. The purpose of this study was to look prospectively at what could be achieved by early systematic diagnostic investigations and, when appropriate, immediate arterial exploration and repair. Methods: Sixty-three pediatric patients with SHF were admitted and treated in our Service between January 2007 and February 2014. Besides clinical examination, they were all investigated by color-coded Duplex scanning (CCDS) and ultrasound velocimetry (UV) of the hand. Eighteen patients were pulseless at first observation. Seven of them presented without signs of ischemia and regained their pulse post-reduction; only dislodgement and compression of the brachial artery (BA) was found in those children. In 11 patients, with pink hand in 7 and severe ischemia (white pulseless hand) in 4, lesions of the BA were detected. All were operated upon by various forms of arterial repair. CCDS and UV were used also intraoperatively and during follow-up (1 m-13 y). Results: All patients had favorable early and long-term results: 8 came back to normal conditions, 2 had persistent paresthesia and weakness of the hand and 1 remained with partial disability of forearm and hand. All BA remained patent. CCDS correctly detected all the lesions preoperatively and showed the patency of the arteries after repair. Conclusion: Early assessment, use of ultrasound investigations and BA prompt repair seem to be the most logical and fruitful strategy at present time.