Limb-threatening events arising subsequent to fixation of pediatric supracondylar
humerus (SCH) fractures are infrequent. We experienced an untoward pulseless hand
in a 9-year-old boy subsequent to reduction and fixation of a SCH fracture with unremarkable
preoperative neurovascular examination. A dilemma persists in consideration of parameters
to assess limb perfusion from an array of investigations. Recently, clinical practice
guidelines in the management of pediatric SCH have been established based on appropriate
use criteria and in compliance, we undertook vascular exploration. We observed a variant
of high brachial artery bifurcation entrapped in the fracture site. The injuries were
appropriately managed without complications and had excellent outcomes in a follow-up
period of 11 months. This index case report of a preexisting brachial artery bifurcation
variant associating a limb-threatening event in postoperative period also highlights
the effective utility of the current practice guidelines in management of pediatric
SCH fractures.
Keywords
postoperative - pediatric supracondylar humerus fracture - vascular entrapment - anomalous
brachial artery bifurcation - humerus - fractures - vascular injuries - brachial artery
