Department of Orthopaedics, Bristol Royal Infirmary, Bristol, United Kingdom.
J Orthop Trauma. 2009 Nov-Dec;23(10):731-3. doi: 10.1097/BOT.0b013e3181a2d825.
A 7-year-old girl presented with a Gartland grade III supracondylar fracture and no radial pulse. After open reduction, it was established that the brachial artery was free of the fracture site; the limb however remained nonviable. The brachial artery was then approached anteriorly and the bicipital aponeurosis was seen to kink the artery. Once the bicipital aponeurosis was released and the remaining spasm treated with arteriotomy and papaverine, a good pulse returned. Despite the fracture being reduced and the artery remaining free of it, there remained a structural impediment to flow in the brachial artery. If the pulse does not return after fixation of a supracondylar fracture, then exploration of the brachial artery is indicated. When a patient is taken to the operating room for fixation of a supracondylar fracture, the facilities and expertise to explore the brachial artery must be made available. In centers where an on-call vascular service is not available, we recommend that the orthopaedic training programs give consideration to including "exploration of the brachial artery" as a facet of orthopaedic surgical training.
一位 7 岁女孩就诊时为 Gartland Ⅲ型肱骨髁上骨折，且桡动脉搏动消失。行切开复位后，发现肱动脉未与骨折端接触，但肢体仍无活力。随后，从前路探查肱动脉，发现肱二头肌腱膜使动脉迂曲。松解肱二头肌腱膜，并用动脉切开术和罂粟碱处理剩余的痉挛后，脉搏恢复良好。尽管骨折已复位且动脉未受其影响，但肱动脉仍存在结构性血流障碍。如果肱骨髁上骨折固定后脉搏未恢复，则需要探查肱动脉。当患者被送往手术室固定肱骨髁上骨折时，必须具备探查肱动脉的设备和专业知识。在没有随叫随到的血管服务的中心，我们建议骨科培训计划考虑将“探查肱动脉”作为骨科手术培训的一个方面。
