Concomitant vascular complications in supracondylar humerus fractures in children

From Januar 1(st) 1990 to December 31(st) 1997, 614 children were treated f or supracondylar humerus fracture at the Department of Orthopedic Surgery i n the Olga Hospital, Stuttgart. Ten of these children had concomitant vascu lar complications. The concept of treatment we had chosen was analysed retr ospectively. The median patient age of the seven girls and three boys with vascular complications was six years. The vascular injuries were diagnosed after admission to the hospital by palpation of the wrist pulse, clinical a ppraisal of the vascularity and by registration of the Doppler signal via t he arteries of the wrist. The emergency operations carried out initially co mprised fragment reposition and fixation with crossed K wires via an access route on the extensor side in all ten children. The subsequent appraisal o f the blood flow revealed a pulse restoration (transient vascular occlusion due to dislocation) in two out of the ten children. In eight out of the te n children, the pulse did not return, which is why the vessel had to be exp lored under emergency conditions. Intraoperatively, we saw a vascular spasm with functional vascular occlusion in one of these eight children. Mechani cal Vascular occlusion were diagnosed in five of these eight children. In a dventitial strangulation (two of these five children), the pulse transmissi on to the hand occured immediately after severance of the strangulation con nective tissue, in intimal damage (three of these five children), the Vascu lar segment concerned was resected and reconstructed, mostly in the form of an end-to-end-anastomosis with venous patch grafting. We observed a combin ed vascular occlusion (mechanical-functional occlusion) in two out of these eight children. in the follow-up investigation, the wrist pulses could be palpated in nine children. Nine children had a physiological signal in colo r duplex sonography, and one child had a pathological monophasic signal ove r the brachial artery, radial artery as well as the ulnar artery. late isch emic damage (cold intolerance, claudicatio, Volkmann's contracture) were no t detected in any of the children. Appraisal of elbow joint mobility reveal ed a median extension deficit of 0 degrees (range 0-10 degrees), a median f lexion deficit of 0 degrees (range 0-15 degrees) and a normal pronation and supination equal on each side. The load-carrying joint axis was normal in a comparison of the sides in all children.