Document Detail


Hand ischemia associated with elbow trauma in children.
MedLine Citation:
PMID:  21571488     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Previous observational studies suggest that children with hand ischemia following elbow trauma can be safely observed if Doppler signals are present in the wrist arteries (pink pulseless hand, PPH). Nonoperative management of PPH is predicated on the assumption that PPH results from local arterial spasm, but the mechanism of arterial compromise has not been investigated. We hypothesized that PPH signifies a brachial artery injury that requires surgical repair.
METHODS: Retrospective review of operations performed on children with hand ischemia following elbow trauma at a level I trauma center pediatric hospital.
RESULTS: Between 2003 and 2010, 12 children (seven males, mean age 7.4 years) underwent brachial artery exploration for hand ischemia following elbow trauma (11 supracondylar fractures, one elbow dislocation) due to falls (n = 10) or motor vehicle crashes (n = 2). At presentation, three subjects had normal radial pulses, eight subjects had Doppler signals but no palpable pulses, and one had weak Doppler flow with advanced hand ischemia. Six of the nine subjects without palpable pulses also had neurosensory changes. All 12 subjects underwent brachial artery exploration either initially (n = 2) or following orthopedic fixation (n = 10) due to persistent pulselessness. At operation, eight of 12 patients (67%) had focal brachial artery thrombosis due to intimal flaps, and four had brachial artery and median nerve entrapment within the pinned fracture site. At discharge, all 12 subjects had palpable radial pulses, but three with entrapment had dense median nerve deficits. One of the three subjects with dense neurologic deficit had complete recovery of neurologic function at ten months. The other two subjects had residual median nerve deficits with partial recovery at 5 and 6 months follow-up, respectively. No patient developed Volkman's contracture.
CONCLUSIONS: Brachial artery injuries should be anticipated in children with hand ischemia associated with elbow trauma. Neurovascular entrapment at the fracture site is a possible complication of orthopedic fixation. Absence of palpable wrist pulses after orthopedic fixation should prompt immediate brachial artery exploration. PPH should not be considered a consequence of arterial spasm in these patients.
Authors:
Pavan Brahmamdam; Mitchell Plummer; J Gregory Modrall; Stephen M Megison; G Patrick Clagett; R James Valentine
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Publication Detail:
Type:  Journal Article     Date:  2011-05-14
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2011-11-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  773-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Brachial Artery / injuries*,  physiopathology,  surgery
Elbow Joint / injuries*,  radiography,  surgery
Female
Fracture Fixation / adverse effects
Fractures, Bone / complications*,  radiography,  surgery
Hand / blood supply*
Hospitals, Pediatric
Humans
Ischemia / diagnosis,  etiology*,  physiopathology,  surgery
Male
Nerve Compression Syndromes / etiology
Radial Artery / physiopathology
Registries
Retrospective Studies
Texas
Trauma Centers
Treatment Outcome
Ultrasonography, Doppler
Vascular Surgical Procedures
Vascular System Injuries / diagnosis,  etiology*,  physiopathology,  surgery

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