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

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

Journal of Pediatric Orthopaedics B: May 2011 - Volume 20 - Issue 3 - p 124–128
doi: 10.1097/BPB.0b013e328342733e
Upper Limb

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.

Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India

Correspondence to S. Rajasekaran, MS, DNB, FRCS, MCh, FACS, PhD, Department of Orthopaedic Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641 011, Tamil Nadu, India Tel: +91 422 4383860/4383861/4383862; fax: +91 422 4383863; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.