The controversial role of ct angiogram in paediatric supracondylar humeral fracture with pulseless, perfused limb

Sharifudin, Mohd Ariff and Paiman, Mohammad and Wan Ismail, Wan Faisham Numan and Wan Sulaiman, Wan Azman and Sadagatullah, Abdul Nawfar and Mohd Shif, Mohd Shukrihizam (2012) The controversial role of ct angiogram in paediatric supracondylar humeral fracture with pulseless, perfused limb. Malaysian Orthopaedic Journal, 6 (2sup.A). p. 98. ISSN 1985-2533

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Abstract

Introduction: Almost 20% of displaced supracondylar humerus fractures in children are complicated by vascular compromise. At present, there is no clear consensus on the management of a persistent pulseless but well-perfused hand after a satisfactory closed reduction of the fracture. The role of angiography in such cases has been a source of controversy and debate. Case Report: An 18-month–old girl was referred to us with a closed, displaced, supracondylar fracture in her left humerus after a fall. She had an impalpable radial pulse but her hand looked pink with a capillary refilling time of less than 2 seconds. She underwent an emergency closed reduction and percutaneous pinning. Post-reduction, her hand remained persistently pulseless but well-perfused. A multi-disciplinary decision was made more than 24 hours after the initial surgery. The medical team decided to proceed with a computerized tomographic (CT) angiogram followed by surgical exploration and release of her left brachial artery, which was completely occluded by compression of the surrounding soft tissues. The procedure proceeded smoothly and the patient showed remarkable immediate and long term outcomes. There was no further complications observed as a result of the delay in surgical treatment. Discussion/ Conclusion:We believe that the decision to manage such cases should be made on based on appropriacy in each case. A CT angiogram is helpful in objectively determining the level of occlusion and the possible risk of proximal migration of thrombus which may eventually affect the available collaterals. A well-perfused limb may allow adequate time for a proper decision to be made for surgical intervention.

Item Type:	Article (Journal)
Additional Information:	5770/29415
Subjects:	R Medicine > RD Surgery > RD701 Orthopedics R Medicine > RJ Pediatrics > RJ101 Child Heatlh. Child health services. Preventive health services for children
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Department of Orthopaedics, Traumatology & Rehabilitation
Depositing User:	DR MOHD ARIFF SHARIFUDIN
Date Deposited:	07 Mar 2013 14:06
Last Modified:	07 Mar 2013 14:06
URI:	http://irep.iium.edu.my/id/eprint/29415

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