Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children

Blunt trauma of the brachial artery (BA) in pediatric age is often associated with neurological and orthopaedic injuries. Acute ischemic hands warrant immediate exploration, but the management of warm-pulseless hands following elbow trauma is controversial. This study evaluates the role of conservative treatment of blunt BA injuries in children with non-threatened hands. Eleven children with blunt trauma onto the BA having warm-pulseless hands were studied retrospectively. After a mean follow-up period of 2.5 = 0.9 years, all cases had thorough clinical examination and duplex scan to assess the treatment outcomes. At the end of follow-up period, all subjects had well-perfused hands with intact wrist pulses. The duplex scan revealed those who had interposition grafts to be patent and one case had an aneurysmal dilatation. There was no statistical significance difference between affected and healthy forearms regarding the mean peak systolic velocity at the wrist, affected side was 62 +/- 0.82 cm/s versus 68 +/- 0.57 cm/s for opposite side (p-value = 0.14). Patients with blunt BA trauma and warm-pulseless hands could be managed safely with conservative treatment, leaving surgical exploration for those who did not regain pulses after 48 hours. Duplex ultrasound can safely verify the patency of surgical repair and can be used for surveillance to detect future complications.