Got Christopher, Tan Tze-Woei, Thakur Nikhil, Marcaccio Edward J, Eberson Craig, Madom Ian
Division of Orthopaedic Surgery and Vascular Surgery, Warren Alpert Medical School at Brown University, 593 Eddy Street, Providence, RI 02903, USA.
J Pediatr Orthop. 2010 Jan-Feb;30(1):57-9. doi: 10.1097/BPO.0b013e3181c80d4f.
Supracondylar fractures of the humerus are the most common elbow fractures in children, accounting for 60% to 70% of all pediatric elbow fractures. These fractures often have neurovascular complications because of deformity and the sharp nature of the fracture fragments. The management of patients who present with diminished or absent pulses, but a well-perfused extremity is a topic of debate. Between 3% and 14% of patients present with an altered vascular examination and a consistent treatment logarithm has not been proposed in the literature. To our knowledge, a brachial artery pseudoaneurysm presenting in a delayed fashion in the setting of a normal vascular examination has not been reported. We report a 6-year-old boy who had a delayed presentation of a brachial artery pseudoaneurysm after a supracondylar humerus fracture, which was repaired with a saphenous vein graft. This is to emphasize close neurological and vascular monitoring even in the setting of a well-perfused hand. In addition, this would suggest that closer postoperative evaluation in significantly displaced fractures should be performed, even beyond the fracture healing stage.
肱骨髁上骨折是儿童最常见的肘部骨折，占所有小儿肘部骨折的60%至70%。由于骨折畸形和骨折碎片锐利，这些骨折常伴有神经血管并发症。对于脉搏减弱或消失但肢体血运良好的患者的处理是一个有争议的话题。3%至14%的患者存在血管检查异常，而文献中尚未提出一致的治疗方案。据我们所知，在血管检查正常的情况下，肱动脉假性动脉瘤延迟出现的情况尚未见报道。我们报告一例6岁男孩，肱骨髁上骨折后出现肱动脉假性动脉瘤延迟表现，采用大隐静脉移植修复。这强调即使手部血运良好，也需密切进行神经和血管监测。此外，这表明对于明显移位的骨折，即使在骨折愈合阶段之后，也应进行更密切的术后评估。
