VASCULAR INJURIES AND THEIR SEQUELAE IN PEDIATRIC SUPRACONDYLAR HUMERAL FRACTURES - TOWARD A GOAL OF PREVENTION

Between 1988 and 1994, 128 consecutive children with grade III supraco ndylar humeral fractures presented for treatment at our hospital. Seve nteen had absent or diminished (detected with Doppler but not palpable ) radial pulses on initial examination. Fourteen of these 17 children recovered pulse (palpable) after reduction and stabilization of their fractures. The remaining three had persistent absence of radial pulse. Each of these three children was explored immediately and found to ha ve a significant vascular injury requiring repair. Two of the 14 child ren who had initially regained their pulses had a progressive postoper ative deterioration in their circulatory status during the first 24-36 h, including loss of the radial pulse. Both of these children had art eriograms that identified vascular injuries. Both underwent exploratio n and bypass grafting. One of these two children had been transferred 48 h after injury, resulting in delay of management of his vascular im pairment. Despite exploration, vascular repair, and fasciotomy, he ult imately developed Volkmann's ischemic contracture. All five children w ith significant vascular injuries had absent or diminished radial puls es on presentation. Immediate reduction and fixation followed by caref ul evaluation and treatment of ischemia were associated with excellent outcome in four of the five children.