The conservative management of the pink pulseless hand in supracondylar humeral fracture in children: A prospective cohort study.

Introduction: Following a pediatric supracondylar humeral fracture, the management of the pink, pulseless hand is debatable. After closed reduction and fracture fix, some surgeons advise close monitoring; nevertheless, if the radial pulse cannot be felt, others advise surgical exploration. Our study aims at assessing functional and vascular outcomes of conservative management of the pink pulseless hand after supracondylar humeral fracture and to identify factors associated with safe conservative management.Methods: A cohort study including 32 children presenting with a pink pulseless hand after supracondylar humeral fracture. Before and after reduction and fixation hand-held Doppler and pulse oximeter were utilized to evaluate distal circulation condition in all patients. An attempt was made to repair the fractures with an urgent closed reduction. A careful examination of the compensated pink pulseless hand was conducted.Results: Out of the 32 study cases, 22 cases restored peripheral pulsations after reduction and fixation while 10 cases were still pulseless, 1 of them underwent brachial artery exploration. The remaining 9 cases were managed conservatively, where no major complications occurred during follow up with perfect limb movement.Conclusion: Our research shows that treating juvenile supracondylar humeral fractures with a pink, pulseless hand requires just cautious monitoring following urgent closed reduction and fixation. Provided that the hand is warm and has adequate blood flow, surgical examination is not required. When evaluating and predicting whether a child with a pink pulseless hand needs brachial artery exploration, handheld Doppler and pulse oximeters are helpful tools.