Vascular compromise associated with supracondylar fractures in children

Objectives: Our aim was to study the significance of persistently absent ra dial pulse, with monophasic doppler flow after close reduction percutaneous pinning of displaced supracondylar fracture of humerus, and the need of ea rly exploration of brachial artery in such cases. Methods: Between July 1992 and 1999, 86 children with Grade III supracondyl ar fracture of humerus were treated at King Khalid University Hospital, Riy adh Kingdom of Saudi Arabia The history, physical examination, vascular sta tus of limb before and after close reduction percutaneous pinning of fractu re were recorded. All children having persistently absent radial pulse and monophasic flow doppler signals after close reduction percutaneous pinning under went exploration of brachial artery. Results: Of the 86 children with Grade III supracondylar fracture of humeru s, 6 had persistently absent radial pulse with monophasic flow doppler sign als after close reduction percutaneous pinning. Five children had one warm pink well perfused hand and one cold pale poorly perfused hand. All 6 under went exploration of brachial artery and were found to have entrapped arter y at the fracture site. There was an immediate return of radial pulse with triphasic Doppler flow oil release or brachial artery. Conclusions: Persistently absent radial pulse with objectivity, obtained by doppler ultrasound in the form of absent or monophasic flow in radial arte ry, is a reliable indicator of vascular compromise. Surgical exploration of brachial artery by a competent surgeon is to be carried out to avoid early and late complication, of pulseless limb in children with displaced suprac ondylar fracture of humerus.