The role of autologous venous grafts in the management of vascular injuries associated with paediatric supracondylar humeral fractures: a systematic review

Supracondylar humeral fractures (SHF) are among the most common paediatric elbow injuries. While the majority are managed successfully with reduction and fixation, a subset presents with vascular compromise requiring surgical intervention. Autologous vein grafting is a recognised technique for arterial reconstruction in adults; however, its long-term efficacy and safety in children remain unclear. This systematic review investigates the patency, complication rates, and functional outcomes of autologous venous grafts used in the management of paediatric SHF with vascular injury. This study adhered to PRISMA and Cochrane guidelines and was prospectively registered on PROSPERO (CRD42024553679). A systematic search was conducted across PubMed, MEDLINE, Embase, Cochrane, and Web of Science. Studies were included if they reported clinical, ultrasonographic, or functional outcomes of paediatric patients (< 18 years) undergoing autologous venous grafting following SHF. Risk of bias was assessed using a modified ROBINS-I, and data synthesis was performed using random effects meta-analysis. Five studies comprising 21 paediatric patients were included. The mean age was 6.1 years with an average follow-up of 7.0 years. All patients underwent brachial artery reconstruction using either a basilic or saphenous vein graft. All grafts remained patent at final follow-up, with 90.5% confirmed via ultrasonography. Complications occurred in 95% of patients, however minor vessel ectasia predominated. Aneurysm (9.9%), thrombus (3.8%), and calcification (8.3%) were rare and did not require further surgery. No cases of ischemic contracture were reported. Subgroup analysis showed no significant difference in outcomes between graft types. Autologous venous grafting is an effective strategy for vascular reconstruction in paediatric supracondylar humeral fractures, demonstrating high patency and low long-term morbidity. However, the high incidence of vessel ectasia and wide variation in outcome reporting underscore the need for standardised follow-up and further research. Systematic review of Level IV studies Level of Evidence III.