Less is More in the Nonoperative Management of Complete Brachial Artery Transection after Supracondylar Humeral Fracture

Supracondylar humeral fractures are the most common fracture of the elbow in children. Despite it being a familiar problem faced by surgeons, there are aspects of its management that remain controversial. Specifically, management of these fractures that result in a pink or perfused hand that remains pulseless after acceptable reduction is expectedly controversial. We present a patient with a supracondylar humeral fracture and loss of pulse. The patient was found to have complete brachial artery transection but maintained a pink and well-perfused hand. It was determined to forgo arterial reconstruction because of concerns of worsening ischemia by damage to the collateral circulation. Despite no arterial reconstruction, the patient had a successful outcome. Therefore, this report highlights that arterial reconstruction may not be required, even in cases of severe brachial artery injury.