Supracondylar Fracture Humerus & Circulation - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes scenerios involving supracondylar fractures of the humerus and the circulation.
The neurovascular status must be examined in patients with supracondylar fractures. Avoid treating the patient with a cast that may cause hyperflexion of the elbow. Bending the elbow too much may affect the brachial artery. 90 degrees of elbow flexion to reduce the fracture may not be acceptable. Choose a different alternative to cast such a pinning (closed or open technique). Remember! Volkmann’s ischemic contracture may occur due to injury to the brachial artery.
Scenarios
1. Patient has good circulation with no radial pulse (hand is perfused)
a. Do closed reduction and pinning as well as in-patient monitoring for 24-48 hours. In order to assess the circulation of the extremity.
2. Cold cyanotic hand (no perfusion or underperfusion)
a. May occur before or after attempting reduction
b. Need to go immediately to operating room for closed or open reduction and pinning.
c. Need to monitor the circulation for anticipation of improvement
d. If there is no improvement immediately, explore the antecubital fossa in order to explore the brachial artery.
e. Have the help of a vascular surgeon
f. If the hand is underperfused or not perfused at all, take the patient to the operating room and do closed reduction and pinning
g. Assess the circulation
h. If the circulation does not come back, need to explore the brachial artery.
i. If you have pulses or no pulses with a knee dislocation then you reduce the knee dislocation.
3. Perfusion disappears during reduction or monitoring
a. If perfusion gets worse after reduction of the fracture, then you need to find out what has happened
b. Need to do open exploration and no arteriogram.
4. Circulation disappears after closed reduction and pinning
a. Reduction caused harm to the patient
b. The pins need to be removed, the fracture needs to be unreduced and check the circulation
c. Check to make sure that the neurovascular bundle does not become trapped in the fracture gap after closed reduction and pinning
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[@geojor]

all good stuff, thanks Dr ...

[@zaidhakami4869]

very informative , thanks alot

[@joyceminer385]

thank
good information

[@rabiulislam7297]

very nice

[@surinderkumar6203]

Nice sir