ABSTRACT
Transient arterial injury is a common complication encountered in the management of pediatric supracondylar humerus fractures, often presenting as a pulseless hand that appears well perfused, also known as the "pink, pulseless hand." Arterial injuries in pediatric humeral shaft fractures, on the other hand, are exceedingly rare, especially in closed fractures. The authors report a rare case of a humeral shaft fracture presenting as a pink, pulseless hand. Although this complication was initially managed according to supracondylar protocol, the patient's neurologic status deteriorated. This prompted vascular assessment with computed tomography angiography, revealing a complete occlusion of the brachial artery. At this more proximal level, there is significant risk for compromise of the collateral circulation. The patient was eventually treated successfully with open reduction of the fracture followed by brachial artery repair. Although watchful waiting may be appropriate in the management of this entity for supracondylar fractures, more aggressive management was indicated for this patient because of the occlusion occurring prior to the bifurcation of the brachial artery. The lack of collateral circulation makes improvement in this injury pattern unlikely. This report emphasizes that suspected vascular injury following humeral shaft fractures should be evaluated with computed tomography angiography. If an occlusion is identified, it should be treated aggressively with immediate open fracture reduction and evaluation by a vascular team for possible repair vs grafting. [Orthopedics. 2019; 42(2):e279-e281.].
