The value of ultrasonic diagnosis in the management of vascular complications of supracondylar fractures of the humerus in children
| Autor: | A. Laurito, Ombretta Martinelli, Ernesto Ippolito, M. Benedetti Valentini, Pasquale Farsetti |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Male
Humeral Fractures medicine.medical_specialty Brachial Artery medicine.medical_treatment Color Duplex scanning medicine.artery Laser-Doppler Flowmetry Settore MED/33 - Malattie Apparato Locomotore Spastic Humans Medicine Orthopedics and Sports Medicine General anaesthesia Humerus Ultrasonography Doppler Color Brachial artery Child Preschool Ultrasonography business.industry Ultrasound Doppler Vascular System Injuries Hand medicine.disease Thrombosis Surgery medicine.anatomical_structure Female Child Preschool Radiology business Watchful waiting |
| Popis: | Of 48 consecutive children with Gartland III supracondylar fractures, 11 (23%) had evidence of vascular injury, with an absent radial pulse. The hand was pink and warm in eight and white and cold in the other three patients. They underwent colour-coded duplex scanning (CCDS) and ultrasound velocimetry (UV) to investigate the patency of the brachial artery and arterial blood flow. In seven patients with a pink pulseless hand, CCDS showed a displaced, kinked and spastic brachial artery and a thrombosis was present in the other. In all cases UV showed reduced blood flow in the hand. In three patients with a white pulseless hand, scanning demonstrated a laceration in the brachial artery and/or thrombosis. In all cases, the fracture was reduced under general anaesthesia and fixed with Kirschner wires. Of the seven patients with a pink pulseless hand without thrombosis, the radial pulse returned after reduction in four cases. The remaining three underwent exploration, along with the patients with laceration in the brachial artery and/or thrombosis. We believe that the traditional strategy of watchful waiting in children in whom the radial pulse remains absent in spite of good peripheral perfusion should be revisited. Vascular investigation using these non-invasive techniques that are quick and reliable is recommended in the management of these patients. Cite this article: Bone Joint J 2013;95-B:694–98. |
| Databáze: | OpenAIRE |
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