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Supracondylar humerus fractures are the most common elbow fractures in children. Because the brachial artery lies anterior to the distal humerus, displaced fractures can cause:
Arterial spasm, Intimal injury, Thrombosis, Entrapment or transection) Vascular injury risk increases significantly with higher Gartland classifications of supracondylar humerus fractures, peaking in Type III and Type IV injuries.
Vascular compromise can lead to ischemia, compartment syndrome, and long-term functional deficits if not promptly identified and treated.
The decision-making around "pink pulseless hand" remains controversial Some centers advocate observation after reduction, while others recommend early exploration.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with intact pulse will be followed up for 48 hours after fixation | No Intervention | ||
| Pink pulseless hand | Other | ): Patients with no pulse, but with good biphasic distal doppler signals, well perfused hand capillary refill time less than 3 seconds, and normal oxygen saturation. Patients in this group will be managed by watchful observation for 48 hours after fixation. Vascular exploration will only be indicated if hand ischemia, loss of distal doppler signals, or deterioration of digital oxygen saturation occur |
|
| Pale pulseless hand | Active Comparator | Patients with no pulse or distal doppler signals, and delayed capillary refill time will undergo immediate vascular exploration and injuries will be documented and managed accordingly. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| vascular exploration | Procedure | Patients with no pulse or distal doppler signals, and delayed capillary refill time will undergo immediate vascular exploration and injuries will be documented and managed accordingly. |
| Measure | Description | Time Frame |
|---|---|---|
| incidence of vascular complications in patients with supracondylar humerus fractures | baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Predictors of vascular complications in pediatric supracondylar humerus fractures. | baseline |
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Inclusion Criteria:
● Children Diagnosed with supracondylar humerus fracture (Gartland I-IV) aged under 15 years.
Exclusion Criteria:
● Old trauma >48 hours
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mina Mamdouh Fakher | Contact | +201017243109 | minamamdouhf1999@gmail.com | |
| Hesham Elsayed Aboloyon | Contact |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Assiut University | Asyut | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Dabis J, Daly K, Gelfer Y (2016): Supracondylar fractures of the humerus in children: a review of management and controversies. Orthopedic & Muscular System, 5(01): 1-4. | ||
| 23632684 | Background | Benedetti Valentini M, Farsetti P, Martinelli O, Laurito A, Ippolito E. The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children. Bone Joint J. 2013 May;95-B(5):694-8. doi: 10.1302/0301-620X.95B5.31042. | |
| 8854319 |
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| Background |
| Schoenecker PL, Delgado E, Rotman M, Sicard GA, Capelli AM. Pulseless arm in association with totally displaced supracondylar fracture. J Orthop Trauma. 1996;10(6):410-5. doi: 10.1097/00005131-199608000-00008. |
| 9449099 | Background | Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus fractures. J Pediatr Orthop. 1998 Jan-Feb;18(1):38-42. |
| 24643672 | Background | Barr LV. Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays. J Child Orthop. 2014 Mar;8(2):167-70. doi: 10.1007/s11832-014-0577-0. Epub 2014 Mar 19. |
| 11269814 | Background | Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001 Jan;10(1):63-7. |
| 29644308 | Background | Leiblein M, Lustenberger T, Schulz AK, Schmitz-Rixen T, Marzi I. Neurovascular complications after supracondylar humerus fractures in children. Trauma Case Rep. 2017 Jan 6;8:16-19. doi: 10.1016/j.tcr.2017.01.013. eCollection 2017 Apr. |
| Background | . Hosam Roshdy M, Khaled El Alfy M, Hesham Sharaf M et al. (2016): Vascular Complications of Supracondylar Humeral Fractures in Pediatrics. Egyptian Journal of Vascular and Endovascular Surgery, 12: 1-5 |
| 29515703 | Background | Usman R, Jamil M, Hashmi JS. Management of Arterial Injury in Children with Supracondylar Fracture of the Humerus and a Pulseless Hand. Ann Vasc Dis. 2017 Dec 25;10(4):402-406. doi: 10.3400/avd.oa.17-00050. |
| 2313426 | Background | Shaw BA, Kasser JR, Emans JB, Rand FF. Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma. 1990;4(1):25-9. doi: 10.1097/00005131-199003000-00004. |
| 23812149 | Background | Garg S, Weller A, Larson AN, Fletcher ND, Kwon M, Schiller J, Browne R, Copley L, Ho C. Clinical characteristics of severe supracondylar humerus fractures in children. J Pediatr Orthop. 2014 Jan;34(1):34-9. doi: 10.1097/BPO.0b013e31829c0046. |
| 29169600 | Background | Lebowitz C, Matzon JL. Arterial Injury in the Upper Extremity: Evaluation, Strategies, and Anticoagulation Management. Hand Clin. 2018 Feb;34(1):85-95. doi: 10.1016/j.hcl.2017.09.009. |
| 24749093 | Background | Mohammadzadeh MA, Mohammadzadeh M, Mohammadzadeh A, Herfatkar R, Mohammadzadeh V, Baghi I, Heydari H, Najafi S, Jalili M. Arterial damage accompanying supracondylar fractures of the humerus. Trauma Mon. 2012 Jan;16(4):160-3. doi: 10.5812/kowsar.22517464.3273. Epub 2012 Jan 15. |
| 12369030 | Background | Wu J, Perron AD, Miller MD, Powell SM, Brady WJ. Orthopedic pitfalls in the ED: pediatric supracondylar humerus fractures. Am J Emerg Med. 2002 Oct;20(6):544-50. doi: 10.1053/ajem.2002.34850. |