Ultrasonographic and Radiographic Features of Pink Pulseless Hand in Pediatric Supracondylar Humerus Fractures
Tomohiro Yasuda, MD, PhD1; Koki Nakamura, MD, PhD1; Keikichi Kawasaki, MD, PhD2; Koji Kanzaki, MD, PhD3; Katsunori Inagaki, MD, PhD4
1Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan, Yokohama, Japan; 2Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan, Yokohama, Japan; 3Showa University Fujigaoka Hospital, Yokohama, Japan; 4howa University School of Medicine, Shinagawa-ku, Tokyo, Japan, Tokyo, Japan
Background It has been reported that brachial artery injuries occur in 12-15% of supracondylar fractures of the humerus in children. However, blood flow is often maintained due to the presence of collateral blood vessels. Therefore, surgery to identify and repair blood vessels is rarely necessary. The management and evaluation of the Pink Pulseless Hand (PPH) is still controversial. In this report, we describe the ultrasonographic and radiographic characteristics of the Pink Pulseless Hand in pediatric supracondylar humerus fractures.
Subjects and Methods The subjects were 32 children operated on for a diagnosis of supracondylar humerus fracture in our hospital. The average age of the patients was 5.2 years (3-11 years). The preoperative X-ray was used to evaluate the fracture type and the shortest distance from the skin to the most distal point of the proximal humeral fragment (s-f distance)(fig1). Preoperative echocardiography was also used to evaluate the torn humerus arm muscle, blood flow before surgery (blood flow) and after manual reduction (blood flow), as well as blood vessel kinking at the fracture site of the humeral artery.
Results The fracture types were Gartland type 2 in 8 cases and type 3 in 24 cases. There were 4 cases of PPH. Radiographic evaluation showed that the s-f distance was 33.0 mm for Gartland 2, 17.2 mm for Gartland 3, 6.6 mm for PPH, and 22.4 mm for non-PPH(P?0.05). The ultrasonographic evaluation showed that patients with non-PPH did not have reduced blood flow without Kinking. All four PPH cases showed decreased blood flow with Kinking. Two of the four PPH patients had improved blood flow(fig2, fig3).
CONCLUSIONS In pediatric patients with supracondylar fractures of the humerus, all cases of PPH showed Kinking on ultrasonographic examination.
Fifty percent of the patients with Kinking showed improvement after restoration. The s-f distance was predominantly shorter in the PPH group. An s-f distance of 7 mm or less is suggestive of PPH. Preoperative radiographs are also predictive of PPH.
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