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Crppf supracondylar fracture12/11/2023 Each of these patients had a pulse oximeter applied intraoperatively and in retrospective analysis were divided into 2 groups. The remaining 26 patients had no palpable radial pulse but had a perfused hand with good capillary refill. Postoperatively, 11 patients had return of the radial pulse. All patients had near anatomic reduction and restoration of the Baumann's angle. All 37 received closed reduction and percutaneous pinning emergently within 6 hours of presenting to the hospital. All were grade III extension-type fractures and were closed injuries. We identified 37 (4.7%) patients presenting with a pulseless hand following a supracondylar humerus fracture. In the emergency department, the above criteria for determining if a hand was pulseless were applied. 781 children sustained displaced supracondylar fractures of Gartland grade IIb or III and were admitted for operative stabilization. 2) is illustrated.Ī total of 3,182 patients presented to our department with a supracondylar humerus fracture from 2005 to 2009. As mentioned above, the pulse oximeter used in this study was a Nellcor N395 pulse oximeter. All patients had immediate postoperative evaluation of the hand in the area of color, perfusion and pulse oximeter waveform readings. The type of operative intervention and the intraoperative findings was examined. We used the modified Gartland's classification system 10) to ascertain the grade of the fracture. Associated nerve palsies and radiographs were reviewed. We reviewed the medical records to determine demographic information, mechanism of injury, perfusion and pulse oximeter readings on admission. The inclusion criteria was a pulseless perfused hand following a supracondylar fracture of the distal humerus as defined by an objective finding of no waveform on the Nellcor N395 pulse oximeter (Coviden, Boulder, CO, USA). Upon admission to the emergency department, all children were examined clinically and had a pulse oximeter probe placed over the ipsilateral hand. All children were followed at least 24 months. This is an Institutional Review Board (IRB) approved retrospective sequential review of case notes and X-rays of all children admitted to our institution between 20 with a displaced supracondylar humerus fracture. The purpose of our study is first to determine the usefulness of pulse oximetry in diagnosis of the pulseless hand and second, its usefulness as a predictor for the need of brachial artery exploration in children who were found to have pulseless perfused hands. Various treatments such as observation, 2) arteriography, 3, 4) magnetic resonance angiography, 4) emergent exploration 5 - 8) and delayed exploration9) have been suggested following fracture stabilization. There is no consensus on the treatment of the pulseless perfused hand following operative fixation. Our study looked specifically at the presence or absence of a waveform of the pulse oximeter in a child who presents with a pulseless hand and the waveform following adequate stabilization via CRPP. This is the group of patients which we are interested in and will be referred to as the "pulseless perfused hand." This group does not need any further intervention, 3) a perfused hand with no radial pulse. This group will most likely require brachial artery exploration, 2) a perfused hand with a good radial pulse. Postfixation, three scenarios manifest: 1) a poorly perfused hand with an absent radial pulse. This forms the basis of investigating the clinical usefulness of a pulse oximeter in pulseless perfused hands both in diagnosis and in deciding for surgical exploration postfixation.Īt presentation to the emergency department, three scenarios manifest: 1) a pulseless hand, 2) a hand with intact but diminished pulse volume in comparison with the contralateral side, 3) a hand with an intact radial pulse. 1) In younger children, the use of clinical assessment and ultrasonographic diagnosis may be difficult due to the fretful nature of the child. The pulseless pediatric supracondylar fracture of the humerus is often treated with emergent operative stabilization with closed reduction and percutaneous pinning (CRPP).
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