Treatment of Supracondylar Humerus Fracture with Brachial Artery Injury in Children

Abstract：Objective To discuss the treatment of Supracondylar humerus fracture with brachial artery injury in children. Methods Ten children suffered Supracondylar humerus fractures(Gartland Ⅲ)with brachial artery injury were treated by surgery from January 2010 to January 2014. Eight of them underwent open reduction through the radial approach and k-wire in-ternal fixation. The other two underwent open reduction through the wood approach and k-wire internal fixation. After that,the brachial artery could be explored clearly. Six cases without brachial artery rupture removed the mechanical compression of the brachial artery first,and then local warm compress and outer membrane injection of papaverine were used. The other four cases with brachial artery rupture underwent embolectomy. Two cases with defect less than 2 cm underwent anastomosis. Two cases with defect more than 2 cm underwent the great saphenous vein grafting. After surgery,anticoagulant therapy was used for one week. Results Ten children were followed up with an average duration of l5 months(ranged from 12 to 18 months). Four to six weeks after operations,X-rays at 4 weeks after operation showed good fracture healing with good bony alignment. On the last follow up,clinical examination revealed a pain free,normal hand function with no vascular deficits. Doppler ultrasound exami-nation were performed and showed unremarkable results. Conclusion Brachial artery injury is one of the most serious compli-cations of supracondylar humerus fracture in children. The patients suspected to have vascular injury should be carefully ob-served. Once diagnose was determined,surgery should be performed as soon as possible. Vascular surgeons can join in the sur-gery if necessary. The efficacy of early surgical treatment is good.