Vascular Injury in Paediatric Supracondylar Humerus Fracture
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
Supracondylar fracture of the humerus is the commonest elbow fracture in children. Displaced extension-type fractures may be associated with brachial artery compromise because of the close relationship of the brachial artery and median/anterior interosseous nerve to the anterior aspect of the distal humerus.
Vascular compromise represents a spectrum from transient arterial spasm or kinking to entrapment, intimal injury, thrombosis or complete arterial disruption. The most important clinical distinction after reduction is between a pulseless poorly perfused hand and a pulseless but well-perfused ("pink") hand.
Critical principle
Pulseless + pale/cold hand = limb-threatening ischemia → urgent fracture reduction and, if perfusion does not return, immediate vascular exploration.
Relevant Patho-anatomy
At the elbow, the brachial artery lies anterior to the distal humerus and enters the cubital fossa medial to the biceps tendon. It divides into the radial and ulnar arteries near the level of the radial neck.
In an extension-type supracondylar fracture, the distal fragment commonly displaces posteriorly while the sharp proximal metaphyseal fragment projects anteriorly, placing the brachial artery and median nerve at risk.
Humeral shaft
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