Vascular Injury Following Supracondylar Humerus Fractures in Children

BACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures.
MATERIAL AND METHOD: 42 pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluations included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications.
RESULTS: In 27 patients radial pulse was palpated following the reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture and the other two were managed with saphenous vein graft and primary repair.
CONCLUSION: It is vital to re-evaluate the patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.

Çocuklarda Suprakondiller Humerus Kýrýðý Sonrasý Damarsal Yaralanmalar

AMAÇ: Çocuk suprakondiller humerus kýrýðý sonrasý ekstremite distalinde nabýz alýnamayan hastalarýn sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Suprakondiler humerus kýrýðý sonrasý ekstremite distalinde nabýz alýnamayan 42 hasta retrospektif olarak deðerlendirildi. Preoperatif ve post operatif nörolojik muayene bulgularý, yaralanma þekli, yaralanma ile hastaneye baþvuru arasýnda geçen süre ve ameliyata alýnma zamaný, hastanede kalma süresi ve ameliyat sonrasý görülen komplikasyonlar açýsýndan hastalar deðerlendirildi.
BULGULAR: Tüm hastalarda Gartland tip 3 kýrýk mevcuttu. Yirmi yedi hastada redüksiyon sonrasý radial nabýz palpe edilmeye baþlandý. On hastada sadece doppler ile belirlenen akým mevcut iken, iki hastada akým alýnamadý. Dolaþým bozukluðu olmayan bu iki hastada da ameliyattan bir gün sonra doppler ile akým alýnmaya baþlandý. Redüksiyon sonrasý dolaþým bozukluðu devam eden ve doppler USG ile akým alýnamayan diðer 3 (%7) hastaya acil vasküler eksplorasyon uygulandý. Bir hastaya primer sütürasyon, diðer 2 hastaya ise saphenous greft ile tamir uygulandý.
SONUÇ: Suprakondiller humerus kýrýðýna baðlý nabýzsýz el geliþen hastalar, redüksiyon sonrasý yeniden deðerlendirilmeli; ekstremite dolaþýmý düzelenler ve dolaþým bozuluðu bulgularý olmayanlar için sadece yakýn takip, dolaþým bozukluðu devam edenlere ise damar tamiri yapýlmalýdýr.