EVALUATION OF LATE BRACHIAL ARTERY EXPLORATION IN PEDIATRIC SUPRACONDYLAR HUMERUS WITH ABSENT PERIPHERAL PULSE AND PINK WARM HAND

Abstract

Background: Brachial artery injury is one of the commonest vascular injuries occurring in pediatric
age group with supracondylar fractures of the humerous (SCHF) with an incidence of 3-14 % of cases
as a result of falling on out stretched hand. The aim of the present study was to prevent all disabilities
resulting from improper vascular intervention with SCHF affecting brachial artery by clearing the
vision on the set point. Patients and methods: A study included 18 pediatric patients with SCHF and
pulseless perfused upper limb were studied. They admitted to ZUH 12 cases were females (66.7%) and
6 were males (33.3%) with age5.5±1.72 (mean±SD).Patients were followed up for a period of 24 hours
after bone fixation. Results: Time interval mean from accident to presentation was 7.44±4.85 and Time
interval from presentation to orthopedic intervention was 1.44±0.41. No cases had Limb ischemia or
Nerve injury and only 4 cases (22.2%) had Rupture brachialis muscle. About 14 cases (77.8%) had no
vascular injury as they spontaneously regained pulse after bone fixation with follow up in the ward,
while three cases (16.6%) had Entrapped brachial artery in fracture site and contused segment and only
one case (5.6%) had Contused segment. Majority of cases had no vascular intervention 14 cases
(77.8%) while 2 cases (11.1%) underwent excision of contused part, thrombectomy and 1ry repair. 2
cases (11.1%) underwent excision of contused segment, thrombectomy and repair by reversed
saphenous graft. Post fixation 14 cases (77.8%) had success of spontaneous pulse regaining at different
times of follow up with a mean of 2.92 ±1.23hours with minimum 0.5 and maximum 8 mostly due to
relief of arterial spasm of brachial artery. 22.2% (4 cases) failed to regain pulse spontaneously at 24
hours of follow up so they underwent vascular exploration. Conclusion: Patients with SCHF and
absent peripheral pulsation while the hand is perfused and pulse was not regained after satisfactory
bone reduction, immediate vascular exploration is not necessary and it is better to follow up the patient
up to 24 hours as long as the hand remains perfused.