Delayed treatment of paediatric supracondylar humerus fracture with neuro-vascular compromise.

Abstract

Introduction: Supracondylar humerus fractures are common in children (3% of all paediatric fractures). Type III fracture is associated with neuro-vascular compromise (10-20%) & the appropriate management was delayed due to various factors. Unavailability of vascular and orthopaedic surgeon both at one place at small health centre is one of them.
Case Report:10-year-old girl was referred to our hospital with a painful left elbow with a history of high-energy trauma. On the first examination, the elbow was found to be swollen and a 4 cm linear surgical wound was observed on the antero-medial aspect of the left elbow, due to limited exposure of artery, done by vascular surgeon at one centre, with feeble distal pulse & painful finger movements were present. Patient presented 5 days later to our centre. We are presenting, the 4-month results of our patient, who got fixed with percutaneous Kirshner-wire after gentle traction and closed reduction.
Clinical discussion: Type III & IV modified Gartland supracondylar fractures are associated with compartment syndrome, neurovascular compromise and VIC. Care should be taken to reduce the fracture at an earliest & getting as anatomical a reduction as possible by orthopaedic surgeon and vascular surgeon should manage the brachial artery compromise in same sitting on an emergent basis.
Conclusion: Type III & IV modified Gartland supracondylar fractures associated with neuro vascular compromise should be sent to a centre where both orthopaedic and vascular surgeon are available for treatment of such type of fractures. Only vascular repair without addressing the fracture fixation is not advisable.