[Significance of the radial artery pulse in dislocated supracondylar fractures of the humerus in children].

The importance of palpable or non-palpable pulsation of the radial artery in children with supracondylar fractures of the humerus is still not correctly appreciated either in the practice or in the literature. Despite the relatively frequent occurrence both the diagnostic and therapeutic procedures are not yet uniform. The objective of this study was to evaluate retrospectively the importance of the pulsation of the radial artery in children with this injury treated in author's departments. Impaired pulsation was recorded in 24 of 244 children (9.8%). In all of 7 patients with impaired pulsation in the years 1984-1992 a vascular operation was made. On the other hand, during the period from 1993 till June 30, 1999, only 4 patients were thus operated on for this reason. In other 7 children pulsation was restored immediately after reposition and percutaneous pinning, while in the remaining 6 children with obstruction of the brachial artery confirmed by triplex Doppler examination pulsation was restored within 1-18 days, always without complications and sequelae. Based on their own results and data in the literature, the authors draw attention to the relative independence of the feared Volkmann's contracture on palpable or non-palpable pulsation of the radial artery and to the minor importance of urgent vascular reconstruction if the collateral circulation is satisfactory. In the case of patent circulation in the hand and forearm muscles a minimal invasive (closed) approach to treatment is possible in spite of concurrent obliteration of the brachial artery, just with reduction and percutaneous pinning of the displaced fracture with K-wires.