Correlation of Duplex Ultrasonography, Audible Doppler Examination, and Clinical Examination in Confirming Vascular Patency in Pediatric Patients with a Type III Supracondylar Humerus Fracture: A Pilot Study.
Patients 0-14 years of age who present to Childrens Medical Center Dallas (CMCD) with a Gartland type iii supracondylar humerus fracture with the presence of an open distal humeral physis and a palpable radial pulse in the injured extremity will be included in this study. We will exclude any patients over 14 years old, patients less than 14 years that are skeletally mature and any patient with an intercondylar distal humerus fracture.
This investigation would mandate that immediately before and after surgical fixation of 15 type 3 supracondylar humerus fractures with a palpable radial pulse, a Doppler exam and real-time vascular duplex study will be performed in the operating room while the patient is still under anesthesia. Duplex scans will be taken of both the injured arm and the contralateral arm. The chief of radiology at CMCD has committed to delegating a certified duplex technologist to perform the intra-operative studies. all studies will be officially read by a CMCD radiologist. We will use the information obtained from this group to establish baseline correlations between a palpable pulse, normal Doppler exam and a duplex scan.
Sub-study: We will examine 20 patients with non-palpable pulses, looking at both the injured and contralateral arm, as discussed previously. We will also follow-up this group of patients 1 year after treatment by re-examining with vascular and clinical exams.
1. All patient 0-14 years old who will undergo surgical treatment for a Gartland type III supracondylar humerus fracture.
2. Patients will have an open distal humeral physis. We will use this as an indication of skeletal immaturity.
3. Patients will present pre- surgical fixation with a palpable radial pulse.
Criteria 1 and 2 listed above will remain, patients will now present pre-surgical fixation with a non-palpable pulse.