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Journal of Pediatric Orthopaedics B:
doi: 10.1097/BPB.0b013e328342733e
Upper Limb

Management of acute ‘pink pulseless’ hand in pediatric supracondylar fractures of the humerus

Ramesh, Perumal; Avadhani, Ashwin; Shetty, Ajoy Prasad; Dheenadhayalan, Jayaramaraju; Rajasekaran, S.

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Abstract

The management of a persistent pink pulseless hand after a satisfactory closed reduction in a pediatric supracondylar fracture of the humerus is controversial. Several recent publications have recommended vascular exploration in contrast to a more conservative approach accepted traditionally. We report the results of seven patients with a mean follow-up of 36.6 months with a persistent pulseless, but well-perfused hand postreduction. All patients were managed conservatively without vascular exploration. A palpable return of the radial pulse was seen in six patients at 3 weeks and at 6 weeks follow-up in the other patient with no long-term dysfunction. We believe that the management of a persistent pink pulseless hand remains a ‘watchful expectancy’. Surgical exploration should be recommended only if there is either severe pain in the forearm persisting for more than 12 h after the injury or if there are signs of a deteriorating neurological function.

© 2011 Lippincott Williams & Wilkins, Inc.

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