Cutting edge Orthopedics

Supracondylar Humerus Fractures • 9  Vascular Assessment Careful assessment of the vascular status of the limb is critical in patients with supracondylar humerus fractures. In addition to noting the color of the skin (pink or white), the presence or absence of the radial pulse at the wrist should be noted. Vascular assessment is typically grouped into three categories: (1) normal, (2) pink and pulseless, and (3) white and pulseless (i.e., dysvas- cular). The pink and pulseless group indicates a limb with brachial artery spasm or injury but sufficient collateral circulation for adequate perfusion [9]. Neurologic Assessment Detailed neurologic evaluation is imperative in children with supracondylar humerus fractures. Sensory and motor function of each nerve should be assessed, when possible. Sensation can be tested in children old enough to understand by checking sensation to light touch in the dorsal webspace between the thumb and index finger for the radial nerve, palmar aspect of the distal and middle segments of the index or middle fingers and distal segment of the thumb for the median nerve [43], and palmar aspect of the distal segment of the small finger for the ulnar nerve (Fig. 9) [19]. Motor function may be difficult to elicit in an anxious child; however, it is a crucial part of the physical exam for the child with a suspected supracondylar humerus fracture. Flexion of the thumb interphalangeal joint or distal interphalangeal joint of the index finger indicates an intact AIN (Fig. 10) [34, 43]. Having the child extend the index finger and hold it steady against the examiner’s gentle adduction force allows assessment of both the radial and ulnar nerves with Fig. 8: Skin puckering within the ecchymotic region suggests that the distal extent of the proximal segment has penetrated the brachialis muscle and other soft tissues and is encroaching the deep dermal tissue (Courtesy of Joshua M. Abzug, MD). r humerus report a d hand or ldren fre- he elbow, rm, wrist, lly report [ 19 ] and s requires to obtain is key and rding the status [ 9 ]. physical inning the not cause ses or sen- Reserving or pain, [ 9 ]. Lastly, any active motion should be carefully noted to assist with the neurologic assessment [ 9 ]. Fig. 4.8 Skin puckering within the ecchymotic region suggests that the distal extent of the proximal segment has penetrated the brachialis muscle and other soft tissues and is encroaching the deep dermal tissue (Courtesy of Joshua M. Abz g, MD)