Pulseless Arm in Association with Totally Displaced Supracondylar Fracture

SUMMARYSeven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed redcuction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpab...

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Veröffentlicht in:Journal of orthopaedic trauma 1996-01, Vol.10 (6), p.410-415
Hauptverfasser: Schoenecker, Perry L, Delgado, Eliana, Rotman, Mitchell, Sicard, Gregorio A, Capelli, Ann M
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container_end_page 415
container_issue 6
container_start_page 410
container_title Journal of orthopaedic trauma
container_volume 10
creator Schoenecker, Perry L
Delgado, Eliana
Rotman, Mitchell
Sicard, Gregorio A
Capelli, Ann M
description SUMMARYSeven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed redcuction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.
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All fractures were reduced and pinned. Closed redcuction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.</description><identifier>ISSN: 0890-5339</identifier><identifier>EISSN: 1531-2291</identifier><identifier>DOI: 10.1097/00005131-199608000-00008</identifier><identifier>PMID: 8854319</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott-Raven Publishers</publisher><subject>Algorithms ; Biological and medical sciences ; Bone Nails ; Bone Wires ; Brachial Artery - injuries ; Brachial Artery - surgery ; Child ; Child, Preschool ; Fracture Fixation ; Fractures, Closed - complications ; Fractures, Closed - surgery ; Fractures, Open - complications ; Fractures, Open - surgery ; Humans ; Humeral Fractures - complications ; Humeral Fractures - surgery ; Injuries of the limb. 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All fractures were reduced and pinned. Closed redcuction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. 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Injuries of the spine</subject><subject>Laser-Doppler Flowmetry</subject><subject>Medical sciences</subject><subject>Multiple Trauma - diagnosis</subject><subject>Pulse</subject><subject>Traumas. 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Injuries of the spine</topic><topic>Laser-Doppler Flowmetry</topic><topic>Medical sciences</topic><topic>Multiple Trauma - diagnosis</topic><topic>Pulse</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schoenecker, Perry L</creatorcontrib><creatorcontrib>Delgado, Eliana</creatorcontrib><creatorcontrib>Rotman, Mitchell</creatorcontrib><creatorcontrib>Sicard, Gregorio A</creatorcontrib><creatorcontrib>Capelli, Ann M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of orthopaedic trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schoenecker, Perry L</au><au>Delgado, Eliana</au><au>Rotman, Mitchell</au><au>Sicard, Gregorio A</au><au>Capelli, Ann M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulseless Arm in Association with Totally Displaced Supracondylar Fracture</atitle><jtitle>Journal of orthopaedic trauma</jtitle><addtitle>J Orthop Trauma</addtitle><date>1996-01-01</date><risdate>1996</risdate><volume>10</volume><issue>6</issue><spage>410</spage><epage>415</epage><pages>410-415</pages><issn>0890-5339</issn><eissn>1531-2291</eissn><abstract>SUMMARYSeven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. 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At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott-Raven Publishers</pub><pmid>8854319</pmid><doi>10.1097/00005131-199608000-00008</doi><tpages>6</tpages></addata></record>
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subjects Algorithms
Biological and medical sciences
Bone Nails
Bone Wires
Brachial Artery - injuries
Brachial Artery - surgery
Child
Child, Preschool
Fracture Fixation
Fractures, Closed - complications
Fractures, Closed - surgery
Fractures, Open - complications
Fractures, Open - surgery
Humans
Humeral Fractures - complications
Humeral Fractures - surgery
Injuries of the limb. Injuries of the spine
Laser-Doppler Flowmetry
Medical sciences
Multiple Trauma - diagnosis
Pulse
Traumas. Diseases due to physical agents
title Pulseless Arm in Association with Totally Displaced Supracondylar Fracture
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