However, conservative management (close observation) is recommended as long as the hand is warm and well-perfused, with the reasoning that collateral circulation of the elbow joint will provide sufficient blood supply for the limb, and vascular exploration such only be carried out when deterioration of the circular status of the limb occurs. reported a high incidence of compartment syndrome associated with a PPH following SHFs, and the incidence has been reported to increase from 0.2–4.5% in cases with co-existing neurovascular compromise. Some clinicians recommend aggressive surgical exploration and vascular reconstruction due to the concern that delaying reconstruction of the artery will lead to compartment syndrome, ischemic contracture, retarded development of the limb, cold intolerance, and so on. However, the optimal treatment for a PPH in terms of whether to perform immediate vascular exploration or manage with close observation is controversial in cases where the radial pulse is still not palpable after CRPP. In pediatric patients, urgent closed reduction and percutaneous pinning (CRPP) is the primary treatment in both situation, and vascular exploration is often required in the case of a pale pulseless hand. While vascular compromise in elderly patients with SHFs is rare due to osteoporosis and low-energy trauma compared with pediatric patients, open reduction and plate fixation was recommended for satisfactory outcomes. Compromised vasculature occurs in 2.6–20% of cases of displaced SHFs in children, with two kinds of brachial artery injuries reported to be associated with SHFs: those presenting with a pale pulseless hand and those with a pink pulseless hand (PPH) which is well perfused without a palpable radial pulse. Supracondylar humerus fractures (SHFs) are the most common fractures in children and account for approximately 50–70% of pediatric elbow fractures. Color-flow Duplex ultrasound is beneficial for assessing vascular compromise and determining treatment strategies. Surgical exploration is not necessary as long as the hand is warm and well perfused. Our study demonstrates that close observation after urgent closed reduction and percutaneous pinning is a sufficient approach for the treatment of pediatric supracondylar humeral fractures accompanied with a pink pulseless hand. All patients achieved excellent limb function. Patients completed an average of 4.5 years of follow-up, during which no major complications occurred. Postoperative color-flow Duplex ultrasound revealed continuity of the artery and rich collateral circulation. The remaining four without a palpable pulse were managed with close observation and no deterioration of the vascular status was observed therefore, no surgical exploration was performed. All cases underwent urgent surgery, after which nine experienced immediate return of the radial pulse. Compression of the artery by the proximal fragment was observed in most cases, with one case of entrapment of the artery between fragments, and thrombus considered in two cases. Preoperative color-flow Duplex ultrasound showed no disruption of the brachial artery in cases detected. Close observation was carried out when the hand was pink and pulseless with an absent radial pulse. Urgent closed reduction and percutaneous pinning of the fractures were attempted first. Preoperative and postoperative color-flow Duplex ultrasound detection was used to assess brachial artery compromise in most cases. Thirteen consecutive children presenting with a pink pulseless hand following supracondylar humeral fracture were enrolled in this study. The present study aimed to analyze the benefits and outcomes of close observation for treating pediatric supracondylar humeral fractures with a pink pulseless hand. Some clinicians recommend close observation after closed reduction and percutaneous pinning of the fractures, while some recommend surgical exploration if the radial pulse is unpalpable. The optimal treatment for pediatric supracondylar humeral fractures accompanied with a pink pulseless hand is controversial.
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