Case 98: Pale hand
An 8 year old boy fell and sustained a humeral fracture. The orthopaedic registrar has reduced and fixed the fracture in theatre. The hand is now noted to be cold and pale.
1. What does the xray show?
A supracondylar fracture of the humerus.
2. What associated injury may be responsible for the hand changes?
Injury to the brachial artery can be occlusion, dissection or transection. This leads to ischaemia of the flexors of the forearm, compartments syndrome and then healing by fibrosis.
3. How would you manage this problem?
Emergency exploration of the brachial artery above the elbow to restore flow. Fasciotomy of the forearm compartments may be rquired if there has been prolonged ischaemia.
4. If untreated what is the likely outcome?
Volkmann's ischaemic contracture.
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