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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1487-1492.
doi: 10.1302/0301-620X.91B11.22170  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood

LONG-TERM FOLLOW-UP

C. M. Blakey, MRCS, Clinical Education Fellow1; L. C. Biant, MS, FRCS Ed(Trauma & Orth), Consultant Trauma and Orthopaedic Surgeon2; and R. Birch, MChir, FRCS, FRCSEng, Professor of Neurological Orthopaedic Surgery3

1 Research and Education, South West London Elective Orthopaedic Centre, Dorking Road, Epsom KT18 7EG, UK.
2 The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
3 The Peripheral Nerve Injury Unit, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.

Correspondence should be sent to Miss L. C. Biant; e-mail: Leela.Biant{at}luht.scot.nhs.uk

A series of 26 children was referred to our specialist unit with a ‘pink pulseless hand’ following a supracondylar fracture of the distal humerus after a mean period of three months (4 days to 12 months) except for one referred after almost three years. They were followed up for a mean of 15.5 years (4 to 26). The neurovascular injuries and resulting impairment in function and salvage procedures were recorded. The mean age at presentation was 8.6 years (2 to 12). There were eight girls and 18 boys.

Only four of the 26 patients had undergone immediate surgical exploration before referral and three of these four had a satisfactory outcome. In one child the brachial artery had been explored unsuccessfully at 48 hours. As a result 23 of the 26 children presented with established ischaemic contracture of the forearm and hand. Two responded to conservative stretching. In the remaining 21 the antecubital fossa was explored. The aim of surgery was to try to improve the function of the hand and forearm, to assess nerve, vessel and muscle damage, to relieve entrapment and to minimise future disturbance of growth.

Based on our results we recommend urgent exploration of the vessels and nerves in a child with a ‘pink pulseless hand’, not relieved by reduction of a supracondylar fracture of the distal humerus and presenting with persistent and increasing pain suggestive of a deepening nerve lesion and critical ischaemia.




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J. E. Robb
The pink, pulseless hand after supracondylar fracture of the humerus in children
J Bone Joint Surg Br, November 1, 2009; 91-B(11): 1410 - 1412.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General