Strategy of pulseless pink supracondylar humerus fracture treatment in children: a comparison of two approaches.
Children
Pink
Pulseless
Supracondylar humerus fracture
Vascular surgery
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
12
04
2021
accepted:
17
09
2021
pubmed:
30
9
2021
medline:
12
10
2022
entrez:
29
9
2021
Statut:
ppublish
Résumé
The appropriate treatment of pulseless pink supracondylar humerus fractures (SCHF) remains controversial. In this study, the outcomes of two treatment approaches (with and without vascular surgery) were compared. This was a retrospective multicenter study of patients with pulseless pink SCHFs treated in ten pediatric surgery, trauma, or orthopedics departments in the Czech and Slovak Republic between 2014 and 2018. Of the total 3608 cases of displaced SCHF, 125 had the pulseless pink SCHF. Of those, 91% (114/125) did not undergo vascular surgery and 9% (11/125) underwent vascular surgery. The patients who did undergo vascular surgery had radial artery pulsation restored more frequently in the operating room (73% vs. 36%; p = 0.02), within 6 h (91% vs. 45%; p = 0.004), and within 24 h of surgery (91% vs. 57%; p = 0.05). However, 72 h after surgery, there was no significant difference in palpable radial artery pulsation between the vascular surgery and the non-vascular surgery groups (91% vs. 74%; p = 0.24). Additionally, no significant differences in long-term neurological (9% vs. 22%; p = 0.46) or circulatory (9% vs. 7%; p = 0.57) deficits were found between the two groups. While vascular surgery in patients with pulseless pink SCHFs is associated with a more prompt restoration of radial artery pulsation, no statistical significant differences in terms of the restoration of neurological deficits or the risks of long-term neurological or circulatory deficits were found between patients with and without vascular surgery.
Identifiants
pubmed: 34585254
doi: 10.1007/s00068-021-01794-x
pii: 10.1007/s00068-021-01794-x
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3785-3791Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Skaggs DL, Flynn JM (2015) Supracondylar fractures of the distal humerus. In: Rockwood and Wilkins' Fractures in children. 8th edition. Lippincot Wolters Kluwer Health, Philadelphia: 581–629
Havránek P, et al. Supracondylar humerus fracture. In: Havránek P, et al., editors. Paediatric fracture (in Czech). Praha: Galén; 2013. p. 112–34.
Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J. Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol. 2016;46(1):61–6. https://doi.org/10.1007/s00247-015-3439-0 .
doi: 10.1007/s00247-015-3439-0
pubmed: 26216157
Scannell BP, Brighton BK, VanderHave KL. Neurological and vascular complications associated with supracondylar humeral fractures in children. JBJS Reviews. 2015;3(12): e2. https://doi.org/10.2106/JBJS.RvW.N.00084 .
doi: 10.2106/JBJS.RvW.N.00084
pubmed: 27490996
Štichhauer R, Preis J, Kanta M, Krobot J. Nerve Injuries in Supracondylar Humeral Fractures in Children (in Czech). Cesk Slovak Neurol N. 2017;113(4):440–5. https://doi.org/10.14735/amcsnn2017440 .
doi: 10.14735/amcsnn2017440
Aksakal M, Ermutlu C, Sarisözen B, Akesen B. Approach to supracondylar humerus fractures with neurovascular compromise in children. Acta Orthop Traumatol Turc. 2013;47:244–9. https://doi.org/10.3944/AOTT.2013.3012 .
doi: 10.3944/AOTT.2013.3012
pubmed: 23999511
White L, Mehlman ChT, Crawford AH. Perfused, pulseless, and puzzling: a systematic review of vascular injuries in pediatric supracondylar humerus fractures and results of a POSNA questionnaire. J Pediatr Orthop. 2010;30:328–35. https://doi.org/10.1097/BPO.0b013e3181da0452 .
doi: 10.1097/BPO.0b013e3181da0452
pubmed: 20502231
Leiblein M, Lustenberger T, Schulz AK, Schmitz-Rixen T, Marzi I. Neurovascular complications after supracondylar humerus fractures in children. Trauma Case rep. 2017;8:16–9. https://doi.org/10.1016/j.tcr.2017.01.013 .
doi: 10.1016/j.tcr.2017.01.013
pubmed: 29644308
pmcid: 5883211
Konstantiniuk P, Fritz G, Ott T, Weiglhofer U, Schweiger S, Cohnert T. Long-term follow-up of vascular reconstructions after supracondylar humerus fracture with vascular lesion in children. Eur J Vasc Surg. 2011;42:684–8. https://doi.org/10.1016/j.ejvs.2011.06.028 .
doi: 10.1016/j.ejvs.2011.06.028
Noaman HH. Microsurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in children. Microsurgery. 2006;26:498–505. https://doi.org/10.1002/micr.20277 .
doi: 10.1002/micr.20277
pubmed: 17001639
Brahmamdam P, Plummer M, Modral JG, Megison SM, Clagett P, Velantine RJ. Hand ischemia associated with elbow trauma in children. J Vasc Surg. 2011;54(3):773–8. https://doi.org/10.1016/j.jvs.2011.03.004 .
doi: 10.1016/j.jvs.2011.03.004
pubmed: 21571488
Louahem D, Cottalorda J. Acute ischemia and pink pulseless hand in 68 of 404 Gartland type III supracondylar humeral fractures in chidren: urgent management and therapeutic consensus. Injury Int J Care Injured. 2016;47:848–52. https://doi.org/10.1016/j.injury.2016.01.010 .
doi: 10.1016/j.injury.2016.01.010
Preis J, Rejtar P. Significance of the radial artery pulse in dislocated supracondylar fractures of the humerus in children (in Czech). Rozhl Chir. 2000;79:348–56.
pubmed: 11077861
Shaw BA, Kasser JR, Emans JB. Rand FF Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma. 1990;4:25–9.
doi: 10.1097/00005131-199003000-00004
Carter CT, Bertrand SL, Cearlex CM. Management of pediatric type III supracondylar humerus fractures in the United States: results of a national survey of pediatric orthopaedic surgeons. J Pediatr Orthop. 2013;33:750–4. https://doi.org/10.1097/BPO.0b013e31829f92f3 .
doi: 10.1097/BPO.0b013e31829f92f3
pubmed: 24025582
Farrow L, Ablett AD, Mills L, Barker S. Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise. Bone Join J. 2018;100-B:1535–41. https://doi.org/10.1302/0301-620X.100B12 .
doi: 10.1302/0301-620X.100B12
Babala J, Horn F, Sýkora L, et al. Supracondylar humerus fracture with vascular injury (in Czech). Rozhl Chir. 2001;10:545–8.
Rasool MN, Naidoo KS. Supracondylar fractures posterolateral type with brachialis muscle penetration and neurovascular injury. J Pediatr Orthop. 1999;19:518–22. https://doi.org/10.1097/00004694-1999070000-000019 .
doi: 10.1097/00004694-1999070000-000019
pubmed: 10413005
Lim KBL, Lim CT, Tawng DK. Supracondylar humeral fractures in children, beware the medial spike angle. Bone Join J. 2013;95B:1290–4. https://doi.org/10.1302/0301-620X.95B9 .
doi: 10.1302/0301-620X.95B9
Harris LR, Arkader A, Broom A, et al. Pulseless supracondylar humerus fracture with anterior interosseous nerve or median nerve injury—an absolute indication for open reduction? J Pediatr Orthop. 2019;39:1–7. https://doi.org/10.1097/BPO.000000000000000001238 .
doi: 10.1097/BPO.000000000000000001238
Mangat KS, Martin AG, Bache CE. The ‘pulseless pink’ hand after supracondylar fracture of the humerus in children. The predictive value of nerve palsy. J Bone Joint Surg Br. 2009;91:1521–5. https://doi.org/10.1302/0301-620X.91B11.22486 .
doi: 10.1302/0301-620X.91B11.22486
pubmed: 19880900
Kálal J, Šťastný E, Trč T. Vascular complication in treatment of supracondylar fractures in children—three causes (in Czech). Ortopedie. 2013;7:193–6.
Erhart S, Lutz M, Larcher P, Blauth M, Attal R. A case of supracondylar humerus fracture with vascular impairment. Open it up? Arch Orthop Trauma Surg. 2013;133:835–9. https://doi.org/10.1007/s00402-013-1743-4 .
doi: 10.1007/s00402-013-1743-4
pubmed: 23589067
Lally KP, Foster CE 3rd, Chwals WJ, Brennan P, Aktinson JB. Long-term follow-up of brachial artery ligation in children. Ann Surg. 1990;212(2):194–6. https://doi.org/10.1097/00000658-199008000-00013 .
doi: 10.1097/00000658-199008000-00013
pubmed: 2375650
pmcid: 1358056
Choi PD, Melikian R, Skaggs DL. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. J Pediatr Orthop. 2010;30:50–6.
doi: 10.1097/BPO.0b013e3181c6b3a8
Weller A, Garg S, Larson AN, et al. Management of the pediatric pulseless supracondylar humeral fracture: is vascular exploration necessary? J Bone Joint Surg Am. 2013;95:1906–12. https://doi.org/10.2106/JBJS.L.01580 .
doi: 10.2106/JBJS.L.01580
pubmed: 24196459
Sanders JO, Heggeness MH, Murray JN, Pezold RC, Sevarino KS. Management of pediatric supracondylar humerus fractures with vascular injury. J Am Acad Orthop Surg. 2016;24:e21–3. https://doi.org/10.5435/JAAOS-D-1500701 .
doi: 10.5435/JAAOS-D-1500701
pubmed: 26735703