EARLY SURGICAL INTERVENTION AND OUTCOMES IN PEDIATRIC SUPRACONDYLAR HUMERUS FRACTURES WITH VASCULAR INJURY: A PROSPECTIVE AND RETROSPECTIVE STUDY

Objective: Supracondylar humerus fractures (SCHFs) are common in children and may be complicated by vascular injury leading to a “pulseless hand.” Prompt recognition and management are crucial to prevent ischemic complications. This study aimed to elucidate the early diagnosis, classification, and outcomes following surgical intervention in pediatric SCHFs with vascular injury. Methods: In this single-center prospective and retrospective analysis, 25 pediatric patients (age<14 y) with Gartland Type II and III SCHFs and concomitant vascular compromise were included between August 2018 and December 2021. Patients with Gartland Type I fractures or age>14 were excluded. Data on mechanism of injury, preoperative vascular status (pale vs. pink pulseless hand), imaging, surgical approach, and vascular repair techniques were analyzed. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and radiographic evaluations of deformity. Results: Of the 25 patients, 76% presented with a pink pulseless hand and 24% with a pale pulseless hand. Vascular intervention was performed in 60% of patients. Brachial artery thrombectomy was the most common procedure (60%), followed by primary arterial anastomosis (26.7%) and venous graft interposition (13.3%). Radial pulse returned spontaneously after bony fixation in 72% of patients. Overall, 20% achieved excellent MEPS, 48% good, and 32% poor outcomes. Cubitus varus deformity occurred in 20% of patients. Statistical analysis demonstrated a significant association between timely vascular intervention and improved functional outcomes (p<0.05). Conclusion: Early recognition and prompt surgical management of vascular injuries in pediatric SCHFs are paramount. Vascular intervention, especially when guided by clinical suspicion and appropriate imaging, improves limb perfusion and functional outcomes. The findings underscore the importance of a standardized management protocol for vascular-compromised SCHFs in children.