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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1521-1525.
doi: 10.1302/0301-620X.91B11.22486  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The ‘pulseless pink’ hand after supracondylar fracture of the humerus in children

THE PREDICTIVE VALUE OF NERVE PALSY

K. S. Mangat, MRCS(Eng), Clinical Fellow in Paediatric Orthopaedics1; A. G. Martin, MBBCh, MSc, FRCS(Trauma & Orth), Consultant Orthopaedic Surgeon2; and C. E. Bache, FRCS(Orth), Consultant Orthopaedic Surgeon1

1 Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
2 ABM University Trust, One Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR, UK.

Correspondence should be sent to Mr K. S. Mangat; e-mail: Karanjit_mangat{at}hotmail.com

We compared two management strategies for the perfused but pulseless hand after stabilisation of a Gartland type III supracondylar fracture. We identified 19 patients, of whom 11 were treated conservatively after closed reduction (group 1). Four required secondary exploration, of whom three had median and/or anterior interosseus nerve palsy at presentation. All four were found to have tethering or entrapment of both nerve and vessel at the fracture site. Only two regained patency of the brachial artery, and one patient has a persistent neurological deficit.

In six of the eight patients who were explored early (group 2) the vessel was tethered at the fracture site. In group 2 four patients also had a nerve palsy at presentation and were similarly found to have tethering or entrapment of both the nerve and the vessel. The patency of the brachial artery was restored in all six cases and their neurological deficits recovered completely.

We would recommend early exploration of a Gartland type III supracondylar fracture in patients who present with a coexisting anterior interosseous or median nerve palsy, as these appear to be strongly predictive of nerve and vessel entrapment.




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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