TWO CASES OF SUPRACONDYLAR HUMERUS FRACTURE WITH VASCULAR AND NERVE COMPROMISE

NGUYEN THANH NHAN PEDIATRIC ORTHOPAEDIC DEPARTMENT HTO

CASE 1
FM, 8 YO, Traffic accident

Median nerve injury No pulse Pink hand

CASE 1

What do you do ? Close VS Open

CASE 1
We are stuck right here ! Help !!!

Brachial artery and median nerve were compressed

Close reduction ?

The severe of displacement plays un important role

Close reduction ???

CASE 1

Median nerve after decompression

CASE 1

Brachial artery after decompression

CASE 1

Post-Op Pulse (+)

CASE 1

CASE 1

2 weeks later

CASE 2

M, 8 YO Fall off from 2M height

Median nerve injury No pulse Pink hand

CASE 2
We are stuck Here again ! Help help !!!

CASE 2

after decompression

CASE 2
Brachial vein thrombosis

Close reduction may make more damage ?

Median nerve injury

CASE 2

CASE 2

CASE 2

Post-Op Pulse (+)

PEDIATRIC UPPER EXTREMITY FRACTURES

(American Academy of Orthopaedic Surgeons-2004)

Algorithm for Supracondylar Humerus Fracture with Vascular Compromise

Assessment and documentation of neuromuscular status upon arrival No neurovascular compromise CRPP as soon as is practical (first 24 hours) Vascular compromise

Splint at 300 To OR urgently

Reduce fracture under flouroscopic imaging

Reduce fracture under flouroscopic imaging

Anatomic reduction

Anatomic reduction blocked by interposed tissue

Pin fixation

Attempt to free entrapped skin with milking

No pulse; Hand perfused (pink)

Check Pulse Good pulse Cast at 700 flexion; observe overnight No pulse; Hand white Cant be reduced

Open reduction, pinning Improvement under anesthesia (10-15 min) No Consult vascular surgeon

Doppler; Splint at 300; very close observation in hospital for 24+ hours Cast/ bivalve cast at 700 ; Discharge

Yes Hand regains color

QUESTIONS
The two case: Supracondylar humerus fracture Gartland III with brachial artery and median nerve compressed (pink hand) Close reduction damage further ? Open reduction and decompression ? The severe of displacement on lateral view radiograph contribute to make a decision