Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries
Abstract
:1. Introduction
2. Methods
2.1. Patients
2.2. Data Collection
- X-ray: Gartland classification of fractures (type 1/type 2/type 3);
- Doppler sonography: vascular lesions at fracture site (thrombosis/crush injury/vasoconstriction), Doppler waveforms (monophasic flow/biphasic flow/triphasic flow) and flow velocity under the fracture site (m/s);
- Multislice CT-A for vascular injuries: short lesion, <5 mm/long lesion, ≥5 mm. Multislice CT-A was indicated for those with ischemic symptoms after unsuccesful conservative fracture treatment using casts.
- Conservative fracture treatment using casts;
- Vascular trauma treatment: intraoperative vascular blockade using papaverine/intraoperative balloon angioplasty of the brachial artery using the Fogarty catheter/Brachial artery graft by great saphenous vein;
- Early result and one-month reexamination were based on clinical assessment, elbow radiograph and Doppler sonography; handling complications included bone displacement and embolism.
2.3. Data Analysis
3. Results
4. Discussion
4.1. Clinical Condition
4.2. Preoperative Imaging
4.3. Efficacy of Vascular Rehabilitation after Treatment
4.4. Vascular Injury, Surgical Management and Related Factors
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Patient (N = 50) |
---|---|
Gender, no. (%) | |
Male | 36 (72.0) |
Female | 14 (28.0) |
Age, years | |
Mean (years) | 5.85 |
Min–Max (years) | 1.5–14 |
Time interval between the beginning of trauma and arrival to the first health facility (hours) | |
Mean (hours) | 12 |
Min–Max (hours) | 1–120 |
Time interval between the beginning of trauma and arrival to the operating room (hours) | |
Mean (hours) | 52.8 |
Min–Max (hours) | 4–168 |
Mechanism of injury, no. (%) | |
High energy trauma | 49 (98.0%) |
Other * | 1 (2.0%) |
Injured side, no. (%) | |
Right arm | 19 (38.0%) |
Left arm | 31 (62.0%) |
Gartland classification of fractures, no. (%) | |
Type II | 4 (8.0%) |
Type III | 46 (92.0%) |
Types of bone fractures, no. (%) | |
Closed fracture | 49 (98.0%) |
Open fracture | 1 (2.0%) |
Ischemia in the upper extremities, no. (%) | |
Cold limb | 11 (22.0%) |
Warm limb | 39 (78.0%) |
Skin color in hand, no. (%) | |
Pink hand | 49 (98.0%) |
Purple hand | 1 (2.0%) |
Before Cast (N = 50) | After Cast (N = 50) | |
---|---|---|
Brachial artery injuries, no. (%) | ||
No assessment | 43 (86%) | 45 (90%) |
Thrombosis | 1 (2%) | 0 (0%) |
Contusion | 2 (4%) | 3 (6%) |
Vasospasm | 4 (8%) | 2 (4%) |
Flow velocity under the fracture site (m/s), mean (SD) | 16 (8.5) | 18.2 (9.7) |
Doppler waveforms | ||
Monophasic flow | 22 (44%) | 25 (50%) |
Biphasic flow | 28 (56%) | 21 (42%) |
Triphasic flow | 0 (0%) | 4 (8%) |
Surgical Treatment (N = 36) | Conservative Treatment (N = 14) | |
---|---|---|
Age group (yrs), Frequency (%) | ||
<3 years | 2 (5.56) | 1 (7.14) |
3–<13 years | 32 (88.89) | 13 (92.86) |
≥13 years | 2 (5.56) | 0 (0.00) |
Patient age, mean (SD) | 6.28 (2.87) | 4.75 (2.06) |
Surgical Treatment (N = 21) | Conservative Treatment (N = 7) | |
Length of lesions on multislice CT-A | ||
Lesions < 5 mm | 1 (16.7%) | 5 (83.3%) |
Lesions ≥ 5 mm | 20 (90.9%) | 2 (9.1%) |
Vasospasm | Vascular Contusion/Thrombosis | |
---|---|---|
Age group (years), no. (%) | ||
<3 years | 2 (100%) | 0 (0%) |
3–<13 years | 22 (68.8%) | 10 (31.2%) |
≥13 years | 0 (0%) | 2 (100%) |
Length of lesions on multislice CT-A, no. (%) | ||
Lesions < 5 mm | 1 (6.7) | 0 (0.0) |
Lesions ≥ 5 mm | 14 (93.3) | 7 (100.0) |
Doppler waveforms, no. (%) | ||
Monophasic flow | 17 (71.4) | 7 (58.3) |
Biphasic flow | 7 (28.6) | 5 (41.7) |
Brachial artery graft, no. (%) | ||
Blockade | 11 (100%) | 0 (0%) |
Angioplasty | 13 (100%) | 0 (0%) |
Anastomosis end-to-end or using graft | 0 (0%) | 12 (100%) |
Postoperative Results | Patient |
---|---|
Embolism immediately after surgery, no. (%) | 1 (2.8) |
Superficial infection immediately after surgery, no. (%) | 2 (5.5) |
Temporary loss of sensation around an incision one month after surgery, no. (%) | 2 (5.5) |
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Vu, T.N.; Phung, S.H.D.; Vo, L.H.; Nguyen, U.H. Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries. Children 2021, 8, 933. https://doi.org/10.3390/children8100933
Vu TN, Phung SHD, Vo LH, Nguyen UH. Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries. Children. 2021; 8(10):933. https://doi.org/10.3390/children8100933
Chicago/Turabian StyleVu, Tu Ngoc, Son Hong Duy Phung, Long Hoang Vo, and Uoc Huu Nguyen. 2021. "Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries" Children 8, no. 10: 933. https://doi.org/10.3390/children8100933