The pulseless supracondylar humeral fracture: Our experience and a 1-year follow-up.

BACKGROUND: Although the pulseless supracondylar humeral fracture (SHF) in children is well known in the bibliography, controversy still exists regarding the treatment strategy. The purpose of this study was: (a) to describe our policy with pulseless hands following SHF and (b) evaluate the functional outcome in a 1-year follow-up.

METHODS: During the years 2013 to 2018 in our department, 23 of 210 children with type III SHF presented with a pulseless hand (20 with a PPH and 3 with a cold, pulseless hand). Fracture reduction was attempted in all patients followed by reevaluation of the vascular clinical status (including a Doppler ultrasound).

RESULTS: In PPH, a palpable radial pulse was present in all patients in less than 48 hours after surgery. Closed reduction was able to improve the vascular status in 1 patient with pale pulseless hand but surgical exploration of the brachial artery was performed in the other two patients. A palpable radial pulse was present 24 hours after surgery in these 3 patients. All patients had good/excellent outcomes at 1-year follow-up.

CONCLUSION: With our study, we want to enhance the traditional dogma of "watchful waiting" in pink pulseless hands following SHF, and we believe that it should not be revisited. In pale pulseless hands following SHF, at least one attempt of reduction and fixation of the fracture is recommended. If the pulse does not return or the vascular status does not improve, immediate surgical exploration of the artery is strongly indicated.

LEVEL OF EVIDENCE: Case series prognostic study, level IV.