{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:32:59Z","timestamp":1772159579785,"version":"3.50.1"},"reference-count":16,"publisher":"World Scientific Pub Co Pte Ltd","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hand Surg Asian-Pac Vol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p> Background: Supracondylar humerus fractures (SHFs) are common paediatric injuries, with high risk of vascular compromise. Some patients present with a \u2018pink, pulseless hand\u2019, caused by occlusion of brachial artery flow but with collateral circulation preserving distal perfusion. Management of these patients remains controversial, especially when resources may be limited for prolonged hospitalisation and serial monitoring by skilled staff. The aim of this study is to present the intraoperative findings, surgical procedures done and outcomes at 6 weeks for patients with paediatric supracondylar fractures with a pink pulseless hand. <\/jats:p><jats:p> Methods: We retrospectively identified 13 patients who presented to a public hospital between January 2019 and May 2023 with a displaced SHF and pink, pulseless hand. All patients underwent an open reduction with an anterior approach allowing for exploration, protection and repair of neurovascular structures. Distal flow was restored in the brachial artery either with topical lidocaine application, thrombectomy or artery reconstruction. <\/jats:p><jats:p> Results: Out of 13 patients, all had intact median nerves and 10 had intact arteries (69%), of which seven were interposed at the fracture site and four were in vasospasm. Of the three patients with true arterial injury (23%), two had a crushed artery and one had thrombosis of the artery. Peripheral pulses were restored within an hour of fracture open reduction in all patients. At final follow-up, a mean 6 weeks postoperatively, all patients had recovered without neurovascular deficit, compartment syndrome or Volkmann ischemic contracture. <\/jats:p><jats:p> Conclusions: In resource-limited settings, we recommend performing open exploration and reduction for patients with SHFs with pink, pulseless hand. This approach prevents iatrogenic neurovascular injury during closed reduction attempts, allows for immediate repair of a brachial artery injury and avoids unnecessary hospitalisation and serial monitoring. <\/jats:p><jats:p> Level of Evidence: Level IV (Therapeutic) <\/jats:p>","DOI":"10.1142\/s2424835524500139","type":"journal-article","created":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T00:26:55Z","timestamp":1710721615000},"page":"118-124","source":"Crossref","is-referenced-by-count":3,"title":["Open Exploration and Reduction of Paediatric Supracondylar Humerus Fracture with Pink, Pulseless Hand in Resource-Limited Settings"],"prefix":"10.1142","volume":"29","author":[{"given":"Sanjana","family":"KANUMURI","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine, Seattle, WA, USA"},{"name":"Harvard Global Orthopaedics Collaborative, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer Kolimi","family":"SUBHANSAB","sequence":"additional","affiliation":[{"name":"Department of Hand and Orthopaedic Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Jayanagar, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran J.","family":"AGARWAL-HARDING","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"},{"name":"Harvard Global Orthopaedics Collaborative, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sathya","family":"VAMSI KRISHNA","sequence":"additional","affiliation":[{"name":"Department of Hand and Orthopaedic Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Jayanagar, Bangalore, Karnataka, India"},{"name":"Harvard Global Orthopaedics Collaborative, Boston, MA, USA"},{"name":"Hand Surgery Unit, Department of Orthopaedics, Trauma and Spine Surgery, Narayana Health City, Bommasandra, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"219","published-online":{"date-parts":[[2024,3,15]]},"reference":[{"key":"S2424835524500139BIB001","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199905000-00011"},{"key":"S2424835524500139BIB002","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.10.054"},{"key":"S2424835524500139BIB003","doi-asserted-by":"publisher","DOI":"10.1016\/s1058-2746(95)80045-x"},{"issue":"1","key":"S2424835524500139BIB004","first-page":"19","volume":"1","author":"Venkatadass K","year":"2015","journal-title":"Int J Paediatr Orthop"},{"key":"S2424835524500139BIB005","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-007-0509-4"},{"key":"S2424835524500139BIB006","doi-asserted-by":"publisher","DOI":"10.1097\/00004694-199609000-00009"},{"key":"S2424835524500139BIB007","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199705000-00007"},{"key":"S2424835524500139BIB008","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199001000-00019"},{"key":"S2424835524500139BIB009","doi-asserted-by":"publisher","DOI":"10.1097\/00004694-199601000-00020"},{"key":"S2424835524500139BIB010","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199003000-00004"},{"key":"S2424835524500139BIB011","first-page":"81","volume":"38","author":"Marck KW","year":"1986","journal-title":"Neth J Surg"},{"key":"S2424835524500139BIB012","doi-asserted-by":"publisher","DOI":"10.1002\/micr.20277"},{"key":"S2424835524500139BIB013","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2013.03.047"},{"key":"S2424835524500139BIB014","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-200109000-00025"},{"key":"S2424835524500139BIB015","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197309000-00018"},{"key":"S2424835524500139BIB016","doi-asserted-by":"publisher","DOI":"10.1097\/01202412-200601000-00011"}],"container-title":["The Journal of Hand Surgery (Asian-Pacific Volume)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.worldscientific.com\/doi\/pdf\/10.1142\/S2424835524500139","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T07:13:14Z","timestamp":1711955594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.worldscientific.com\/doi\/10.1142\/S2424835524500139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,15]]},"references-count":16,"journal-issue":{"issue":"02","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1142\/S2424835524500139"],"URL":"https:\/\/doi.org\/10.1142\/s2424835524500139","relation":{},"ISSN":["2424-8355","2424-8363"],"issn-type":[{"value":"2424-8355","type":"print"},{"value":"2424-8363","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,15]]}}}