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Research Article

JCDR. 2021; 12(3): 1637-1642


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

Mahmoud Mohamed M. Mahdy, Waleed Abdelbadee Sorour, Sherif Mohamed Hulaeel,Mahmoud Mohamed Salem.


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.

Key words: Brachial Artery; SCHF; Peripheral Pulse; Pink Warm Hand






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