Our Summary

This study looked at the best way to treat children who have broken their arm near the elbow (a type of fracture known as a supracondylar humerus fracture) and have a pink hand but no pulse in it. This is a common injury in children, but it can cause serious complications such as damage to the nerves or blood vessels.

The researchers examined the medical records of children under 16 who had this type of fracture and this specific symptom between 2016 and 2021. They looked at details like the children’s characteristics, their treatment, and what their outcomes were, to try and predict which children might have injuries to their arteries that need repairing, and to figure out the best time to do exploratory surgery.

They found that most of these fractures were caused by falls on outstretched arms, and most of the children were boys around 6 years old. Two thirds of the children had a return of their pulse after having a certain type of treatment (called closed reduction and percutaneous pinning or CRPP), which meant they didn’t need any further vascular exploration. However, among those children who still didn’t have a pulse in their hand 72 hours after CRPP, most were found to have injuries to their brachial artery, and all of these children lost their pulse again after surgery.

In summary, the researchers concluded that urgent CRPP is a good initial treatment for children with this type of fracture and a pink, pulseless hand, and that immediate vascular exploration is usually not needed. However, more research is needed to figure out the best treatment for those children who continue to have no pulse in their hand or lose their pulse again after surgery.

FAQs

  1. What is the optimal treatment for children with supracondylar humerus fractures and a pink pulseless hand?
  2. What is the significance of a persistently absent radial pulse 72 hours after closed reduction and percutaneous pinning in children with supracondylar humerus fractures?
  3. What further research is needed in the management of children with supracondylar humerus fractures and a pink pulseless hand?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hand surgery for a pink pulseless hand following a supracondylar humerus fracture is that urgent reduction and percutaneous pinning are effective initial treatments. Vascular exploration is generally not necessary in these patients, but if the pulse remains absent after 72 hours, further evaluation may be needed. It is important to follow up closely with your healthcare provider to monitor for any changes in blood flow to the hand.

Suitable For

Patients who are typically recommended for hand surgery include those with conditions such as:

  • Supracondylar humerus fractures in children with a pink pulseless hand
  • Brachial artery injuries
  • Neurovascular injury following hand trauma
  • Tendon injuries or tears in the hand
  • Arthritis affecting the hand joints
  • Carpal tunnel syndrome
  • Dupuytren’s contracture
  • Trigger finger
  • Hand deformities or malformations
  • Ganglion cysts
  • Nerve compression syndromes

It is important for patients to consult with a hand surgeon to determine the most appropriate treatment plan for their specific condition.

Timeline

Before hand surgery:

  1. Child sustains a supracondylar humerus fracture (SCHF), often from a fall onto an outstretched arm.
  2. Child presents with a pink pulseless hand, indicating potential arterial injury.
  3. Medical records are reviewed to assess the need for exploratory surgery.

After hand surgery:

  1. Urgent reduction and closed reduction and percutaneous pinning (CRPP) are performed as initial treatments.
  2. Most patients experience a return of pulse following CRPP, avoiding the need for vascular exploration.
  3. In cases where the radial pulse remains absent after 72 hours, vascular injuries are diagnosed in the majority of patients.
  4. Recurrent pulse loss may occur after surgery in patients with brachial artery injuries.
  5. Further research is needed to determine optimal management for persistent pulselessness and recurrent pulse loss in children with SCHF and a pink pulseless hand.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hand surgery for my specific condition?
  2. What is the success rate of the surgical procedure for treating supracondylar humerus fractures with a pink pulseless hand?
  3. How long is the recovery process expected to take after hand surgery?
  4. Will physical therapy be necessary after the surgery, and if so, what will it entail?
  5. Are there any alternative treatment options to surgery that I should consider?
  6. How many surgeries of this type have you performed, and what is your success rate?
  7. What type of anesthesia will be used during the surgery, and what are the potential side effects?
  8. What should I expect in terms of pain management following the surgery?
  9. Will I need to follow any specific post-operative care instructions or restrictions?
  10. What is the likelihood of needing additional surgeries or treatments in the future for this condition?

Reference

Authors: Phan MDM, Tran QN, Vo NQD, Lam KT, Nguyen PD. Journal: J Hand Surg Asian Pac Vol. 2024 Dec;29(6):554-560. doi: 10.1142/S2424835524500462. Epub 2024 Nov 14. PMID: 39544037