Hand and Microsurgery Section, Orthopedic Department, Rikshospitalet, Songsvannsveien 20, Oslo, Norway.
J Orthop Trauma. 2011 Jan;25(1):26-30. doi: 10.1097/BOT.0b013e3181db276a.
Neurovascular injuries in children with dislocated supracondylar humeral fractures are not uncommon. Closed reduction and pin fixation usually will restore the circulation. In some patients, there is still compromised circulation and a neurologic deficit, and they are treated with open exploration and microvascular reconstruction. We have investigated the clinical and functional outcome more than 1 year after the injury in this most serious group of patients.
Retrospective follow-up study.
During 2001 to 2007, five patients were referred to our department with a pale, pulseless hand and circulatory impairment with absent or slow capillary refill after primary treatment with closed reduction and cross pinning at their local hospital for Gartland Type III supracondylar fractures. Two of the patients also had clinical signs of nerve injury.
All were reoperated on with open exploration and release of the entrapped brachial artery. Vascular reconstruction was performed in four patients (vasodilating agent was sufficient in one patient) and release of the median nerve from the fracture in two. One of these two also had a Kirschner wire pierced through the ulnar nerve. All fractures were rereduced and cross-pinned. No intra- or postoperative complications were seen. OUTCOME/RESULTS: At follow-up more than 1 year after the injury, all patients exhibited normal and symmetric function in their upper extremities, including circulation, neurologic status, range of motion, grip strength, and key pinch strength. Clinical and radiologic appearance was normal.
Pulseless arms after repositioning of dislocated supracondylar humeral fractures are a medical emergency. After open release and, if necessary, microvascular reconstruction of vessels and nerves, fracture reduction, and fixation, excellent clinical long-term outcome can be expected. The procedure can be carried out with a low rate of complications.
儿童髁上骨折合并神经血管损伤并不少见。闭合复位克氏针固定通常可恢复血运。但有些患者血运仍受影响且存在神经功能缺损，需要行切开探查和微血管重建。我们对这组病情最严重的患者进行了受伤 1 年以上的临床和功能随访。
回顾性随访研究。
2001 年至 2007 年，5 例 Gartland Ⅲ型髁上骨折患儿在当地医院行闭合复位克氏针固定后，出现手部苍白、无脉搏、循环障碍，毛细血管再充盈缓慢或消失，转至我科。其中 2 例有神经损伤的临床体征。
所有患者均行切开探查，松解卡压的肱动脉。4 例患者行血管重建（1 例应用血管扩张剂），2 例患者行骨折处正中神经松解。其中 1 例合并尺神经被克氏针穿过。所有骨折均重新复位并交叉克氏针固定。术中、术后均未见并发症。
受伤后 1 年以上随访时，所有患者上肢功能均正常且对称，包括循环、神经状态、活动范围、握力和捏力。临床和影像学表现正常。
复位后出现无脉搏的手臂是一种医疗急症。行切开松解，必要时行血管和神经的显微重建、骨折复位和固定后，可获得良好的长期临床效果。该术式并发症发生率低。
