ĐIỀU TRỊ BÀN TAY HỒNG MẤT MẠCH TRONG GÃY TRÊN LỒI CẦU XƯƠNG CÁNH TAY Ở TRẺ EM

Abstract

Background: Supracondylar humeral fractures (SCHF) are among the most common pediatric fractures, accounting for approximately 3% of all fractures in children and 55 - 80% of elbow fractures [2], [3], [5]. Owing to the intimate anatomical relationship between the distal humerus and adjacent neurovascular structures, these injuries are frequently associated with neurovascular compromise, particularly in markedly displaced fractures. The reported incidence of vascular injury ranges from 3% to 20%. Inadequate assessment or management may result in severe complications, including compartment syndrome, limb ischemia, or Volkmann ischemic contracture [1], [4], [7]. While immediate vascular exploration is widely accepted in cases of a poorly perfused limb, the optimal management of the “pulseless but well-perfused” (pulseless pink) hand remains controversial [6], [8]. Purpose: To determine the appropriate timing and indications for surgical vascular exploration in pediatric patients presenting with a pulseless pink hand following SCHF. Methods: A retrospective cohort study was conducted on pediatric patients (<16 years) treated for SCHF with an absent radial pulse at a tertiary orthopedic trauma center between January 1, 2016 and June 30, 2021. Clinical presentation, radiographic findings, treatment strategies, and follow-up outcomes were reviewed. The predictive value of clinical and imaging features for true brachial artery injury requiring repair was analyzed. The timing of vascular exploration was evaluated in relation to postoperative evolution and clinical outcomes. Results: Eighty-eight patients with SCHF and absent radial pulse were identified. Of these, 85 (96.6%) presented with a well-perfused extremity (pulseless pink hand), whereas 3 (3.4%) had signs of poor perfusion (pale, cold, pulseless hand). The mean age was 6.1 ± 2.6 years, with a male predominance (57.9%). The left extremity was more frequently involved (56.8%). The most common mechanism of injury was a fall onto an outstretched hand with the elbow in hyperextension. The majority of cases involved severely displaced fractures, predominantly Gartland type IIIB (86.4%) with posterolateral displacement. Clinical features such as open fracture, anterior elbow ecchymosis, skin puckering, gross instability, and associated nerve injury were not statistically predictive of true brachial artery injury but were suggestive of high-energy trauma and warranted careful assessment. Closed reduction and internal fixation (CRIF) alone resulted in satisfactory outcomes in 65.8% of cases without the need for vascular exploration. Among patients who failed to regain a palpable radial pulse within 72 hours postoperatively, 83.3% were found to have true brachial artery injury requiring intervention. All patients with recurrent postoperative loss of pulse (100%) had confirmed arterial injury. Conclusions: In pediatric SCHF presenting with a pulseless but well-perfused hand, fracture stabilization alone is an effective initial management strategy with a high success rate, obviating the need for immediate vascular exploration in most cases. Delayed vascular exploration should be strongly considered in patients who do not demonstrate return of radial pulse within 72 hours despite adequate limb perfusion, as well as in all cases of recurrent pulse loss.