PDF(Pubmed)
Abstract：
Limb-threatening events arising subsequent to fixation of pediatric supracondylar humerus (SCH) fractures are infrequent. We experienced an untoward pulseless hand in a 9-year-old boy subsequent to reduction and fixation of a SCH fracture with unremarkable preoperative neurovascular examination. A dilemma persists in consideration of parameters to assess limb perfusion from an array of investigations. Recently, clinical practice guidelines in the management of pediatric SCH have been established based on appropriate use criteria and in compliance, we undertook vascular exploration. We observed a variant of high brachial artery bifurcation entrapped in the fracture site. The injuries were appropriately managed without complications and had excellent outcomes in a follow-up period of 11 months. This index case report of a preexisting brachial artery bifurcation variant associating a limb-threatening event in postoperative period also highlights the effective utility of the current practice guidelines in management of pediatric SCH fractures.
摘要：
小儿肱骨髁上（SCH）骨折固定后出现的威胁肢体事件很少见。在手术前神经血管检查不明显的情况下，我们在一个9岁的男孩中经历了无脉的手，随后对SCH骨折进行了复位和固定。从一系列调查中考虑评估肢体灌注的参数仍然存在困境。最近,根据适当的使用标准和合规性，制定了儿科SCH管理的临床实践指南。我们进行了血管探查。我们观察到骨折部位夹入了高肱动脉分叉的变体。损伤得到了适当的处理，没有并发症，并且在11个月的随访期内取得了良好的结果。此索引病例报告显示，先前存在的肱动脉分叉变异与术后威胁肢体事件相关，也强调了当前实践指南在小儿SCH骨折管理中的有效实用性。
