Absence of Radial Pulse in Displaced Supracondylar Fracture of Humerus in Children

Background-Supracondylar fracture of the humerus is a relatively common injury in children and is the most common fracture in this age that requires surgery. Absence of the radial pulse is not a rare accompanying sign of this type of fracture. Cases displaying this condition are occasionally referred to centers with vascular and orthopedic surgery facilities, including Sina Hospital, a trauma referral center, downtown Tehran. The patients are dispatched to these centers with minimum intervention at the time of presentation. This act will lead to undue loss of time and patient inconvenience. The present study was designed to establish a logical approach to this important orthopedic emergency.Methods-Out the 61 patients admitted for displaced supracondylar fracture over a 5-year interval, 21 had absent radial pulse. The orthopedic or vascular surgery interventions along with the aftermath were studied.Results-From the 21 patients with absent radial pulse, vascular surgery had been performed only in 4 patients. Exploration of vessels was normal with spasm and without structural injury or occlusion in 2 cases. Venous graft for repair was done in the other 2 cases who had delayed capillary filling. In the remaining 17 patients with normal capillary filling, vascular surgery had not been performed and therapeutic results were satisfactory.Conclusion-In a child with a displaced supracondylar fracture of the humerus and absent radial pulse, the presence of normal capillary filling, similar to the other limb, is a reliable sign for effective circulation. With this finding, the orthopedic surgeon can manage the patient without vascular surgery facilities. Delayed capillary filling however needs emergency vascular surgery consultation.