A case of supracondylar humerus fracture with vascular impairment. Open it up?

Supracondylar humerus fracture is one of the most frequent fractures in childhood. A serious complication is an injury to the neurovascular structures which could potentially result in severe functional impairment. We are presenting the case of a 3-year-old girl with a supracondylar humerus fracture in our emergency department and highlight the diagnostic and therapeutic steps in managing this situation. Initially, the hand was well perfused but showed to be pulseless in the operating theater after preparation for surgery. After open reduction and internal pin fixation the neurovascular structures were explored and the brachial artery was repaired by means of a cephalic vein graft. On follow up the patient presented with normal hand function and without vascular or neurologic deficits. As concomitant vascular injuries after supracondylar humerus fractures are rare, it can be difficult to discriminate a pink pulseless hand from a patient with essential vascular injury. Our case also demonstrates the need for short-term reevaluation of the clinical status. When in doubt there should be no hesitation to perform open surgery and vascular repair.