Vascular Injury Due to Humerus Fracture in Pediatric Age: When the Treatment Is Mandatory

Background: Pink pulseless hand syndrome is a rare condition of vascular injury due to distal humerus fracture. It is characterized by radial and ulnar pulselessness in a complex of good hand perfusion which can remain pink and warm. The management and treatment of this condition is still very debated. Methods: We report 4 cases of arm traumas which occurred in pediatric patients. In all cases, after the fixation of the fracture by the orthopedic surgeon, the clinical evaluation and duplex ultrasound demonstrated the so called pink pulseless hand syndrome.'' Results: We decided to proceed with an immediate surgical exploration and decompression followed by a prompt recovery of the pulsatility. Postoperative course was uneventful. At 3-year follow-up, the young patients have a normal hand function with no neurovascular damages and regular peripheral signals. Conclusions: Physical and ultrasound examination in cases of pediatric humerus fractures is important to show vascular complications before the orthopedic treatment which is usually privileged. In case of vascular damages, urgent surgical exploration can be the unique choice for a correct treatment.