Treatment of pink pulseless hand after supracondylar fractures of the humerus in children using glucocorticosteroids and plaster slab
|IJOCP | Volume – 2015| Issue – 2015| Article ID – 2015:111
Conference: Indian Orthopaedic Association Annual Conference IOACON-2013, India [Click for Full details]
Authors: Khare G N
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The treatment of a persistent pink pulseless hand after supracondylar fracture of humerus in children is controversial. Early revascularisation has a high rate of asymptomatic reocclusion and residual stenosis. therefore revascularisation should be done only if there is deteriorating nerve function or persistent severe pain even after 12 hours of injury.
26 such patients were seen by the author. The followup ranges from 2-8 (average 5.1) yrs. In 13 cases pulse returned after close reduction of the severely displaced fractures (grade3). A POP slab was applied in full pronation. The remaining 13 where pulse did not return after reduction were subjected to CT angiography (with 64 slice CT scan). A block in brachial artery was demonstrated in all the patients. As the reduction by closed manipulation and POP slab was satisfactory and the hand was pink, well perfused we continued the POP slab without any vascular surgery or exploration.
We used prednisolone 10 mg thrice a day for 3 days to prevent compartment syndrome and reduce edema so that collateral circulation could develop well. None of our cases had progressively deteriorating nerve function or persistent severe pain after 12 hours of injury. All our cases recovered full function of the limb uneventfully. The radial pulse reappeared in 8 cases after 3 weeks and in 5 cases after 6 weeks. It is concluded that most of the pink pulseless hands after supracondylar fractures of the humerus can be managed conservatively. There are plenty of arterial anastamosis around the elbow and collateral circulation can take care of the forearm and hand If we can take care of compartment syndrome. We used g l u c o c o rt i c o st e r o i d s f o r t h is p u r p o s e .
Glucocorti costeroids are the most potent antiinflammatory drugs to reduce the pain, swelling and compartment syndrome dramatically and immediately.
|How to Cite this Abstract|
|Khare G N. Treatment of pink pulseless hand after supracondylar fractures of the humerus in children using glucocorticosteroids and plaster slab. International Journal of Conference Proceedings 2015;(2015):111|