THE TREATMENT OF SUPRACONDYLAR FRACTURES IN CHILDREN WITH AN ABSENT RADIAL PULSE

The purpose of this study was to determine the outcome of patients wit h a supracondylar fracture and an absent radial pulse. All children wi th displaced extension-type supracondylar fractures from 1984-1992 wer e eligible. Of 326 children with supracondylar fractures, 22 had an ab sent radial pulse on admission. Fifteen of the 22 children had a well- perfused hand after closed reduction and K-wire fixation, Five had no pulse but a well-perfused hand after reduction and immobolization of t he elbow in slight flexion none had any problem al final review. Seven patients who had a cold white hand after closed reduction received op en reduction of fracture and arterial exploration. In conclusion, the initial treatment for children with displaced supracondylar fractures with an absent radial pulse should be closed reduction, K-wire fixatio n, and immobilization in <90 degrees of flexion. Children who have a w ell-perfused hand but an absent radial pulse after satisfactory closed reduction do not necessarily require routine exploration of the brach ial artery.