Paediatric Surgery (Ukraine). 2025. 4(89): 101-108. doi: 10.15574/PS.2025.4(89).101108
Levytskyi A. F., Sobolevskiy Y. L., Lykhodii V. V., Коvalchuk D. Y.
Bogomolets National Medical University, Kyiv, Ukraine

For citation: Levytskyi AF, Sobolevskiy YL, Lykhodii VV, Коvalchuk DY. (2025). Neurovascular disorders in supracondylar fractures of the distal humerus in children and adolescents. Paediatric Surgery (Ukraine). 4(89): 101-108. doi: 10.15574/PS.2025.4(89).101108.
Article received: Sep 13, 2025. Accepted for publication: Dec 12, 2025.

Supracondylar fracture of the distal humerus (SFDH) is a common traumatic injury in pediatric practice, accounting for about 60% of fractures in the elbow joint. Complications caused by nerve and vascular damage can be primary or secondary, arising during the treatment of fractures. Nerve damage occurs in 5.8-14% of children, and the frequency of vascular injuries ranges from 3.2% to 14.3%. A distinction is made between a “pink, pulseless, perfused hand” and a “pale, cold, pulseless hand.” Both cases require urgent treatment. However, a number of issues remain debatable regarding the content, nature, and scope of such treatment, as well as the timing of its implementation.
Aim – to determine the current tactics for treating neurovascular disorders in SFDH in children and adolescents.
The research methodology is based on the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines". The search for literature sources was carried out using modern domestic and foreign databases, the depth of the search – over the last 5-7 years using the following terms: "supracondylar fractures of distal humerus in pediatric patients", "treatment", "neurovascular disorders". According to the results of the analysis of literary sources, the tactics of treating vascular complications are based on establishing the degree of their impairment, which is traditionally defined as a pink/pale hand without a pulse. In both cases, urgent reduction of fragments and internal fixation are recommended. Further tactics depend on the results of monitoring the state of blood supply, in the objectification of which three-phase Dopplerography plays an important role. With negative indicators and signs of compartment syndrome, urgent surgical intervention is indicated to determine the factors of vascular disorders and their elimination. The treatment of neurological disorders depends on the degree of sensory and motor disorders. In case of neurapraxia, expectant management is justified, while in case of neurotmesis, which is characterized by persistent neurological deficit, neurosurgical intervention is indicated.
Conclusions. Neurovascular complications in SFDH in children and adolescents occur in about 14% of cases, requiring urgent reduction and internal fixation of the fragments. Further treatment tactics for damage to nervous structures depend on the degree of sensory and motor disorders, and for vascular disorders – on the indicators of clinical and instrumental monitoring.
The authors have no conflicts of interest to declare.
Keywords: supracondylar fractures of distal humerus in pediatric patients, neurovascular disorders, treatment.

REFERENCES

1. Afaque SF, Singh A, Maharjan R et al. (2020). Comparison of clinic radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial. J Clin Orthop Trauma. 11(2): 259-263. https://doi.org/10.1016/j.jcot.2019.01.013; PMid:32099290 PMCid:PMC7026539

2. Azarias Santos I, Crus MAF, Souza RC et al. (2024). Epidemiology of Supracondylar Fractures of the Humerus in Children. Archives of health investigation. 13(1): 18-23. https://doi.org/10.21270/archi.v13i1.6324

3. Chrenko R, Hanko M, Grega M et al. (2024). Peripheral nerve injuries associated with dislocated supracondylar fractures of distal humerus in children: incidence and need of surgical treatment. Childs Nerv Syst. 40(11): 3771-3776. https://doi.org/10.1007/s00381-024-06497-3; PMid:38886222

4. Deininger S, Antoniadis G, Pedro MT. (2024). Funktionelle Ergebnisse peripherer Nervenverletzungen nach kindlichen suprakondylären Humerusfrakturen: Vergleich operativer und konservativer Behandlung. Handchir Mikrochir Plast Chir. 56(1): 93-98. https://doi.org/10.1055/a-2254-2465; PMid:38508207

5. Delniotis I, Delniotis A, Saloupis P et al. (2019). Management of the Pediatric Pulseless Supracondylar Humeral Fracture: A Systematic Review and Comparison Study of "Watchful Expectancy Strategy" Versus Surgical Exploration of the Brachial Artery. Ann Vasc Surg. 55: 260-271. https://doi.org/10.1016/j.avsg.2018.05.045; PMid:30081162

6. Duffy S, Flannery O, Gelfer Y et al. (2021). Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol. 31(5): 871-881. https://doi.org/10.1007/s00590-021-02932-2; PMid:33744996 PMCid:PMC8233294

7. Goh WCK, Ong EJY, Lee NKL et al. (2024). Systematic review of paediatric pulseless pink humerus supracondylar fractures. J Pediatr Orthop B. 33(5): 468-476. https://doi.org/10.1097/BPB.0000000000001149; PMid:38189745

8. Graff C, Dounas GD, Sung J et al. (2022). Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: A systematic review. Journal of Children's Orthopaedics. 16(5): 366-373. https://doi.org/10.1177/18632521221124632; PMid:36238145 PMCid:PMC9551003

9. Gutwerk A, Behrendt P, Vetter S et al. (2022). Retrospective mid term follow up of posttraumatic and iatrogenic neurovascular complications in surgically treated paediatric patients with distal humerus fracture. Children (Basel). 9(9): 1349. https://doi.org/10.3390/children9091349; PMid:36138658 PMCid:PMC9497747

10. Harris LR, Arkader A, Broom A et al. (2019). Pulseless Supracondylar Humerus Fracture With Anterior Interosseous Nerve or Median Nerve Injury – An Absolute Indication for Open Reduction? J Pediatr Orthop. 39(1): 1-7. https://doi.org/10.1097/BPO.0000000000001238; PMid:30080770

11. Heyer JH, Mitchell SL, Garcia S et al. (2022). A Modern Day Timeline for In-Hospital Monitoring in Perfused, Pulseless Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop. 42(10): 589-594. https://doi.org/10.1097/BPO.0000000000002241; PMid:35980760

12. Hope N, Varacallo MA. (2023, Aug 4). Supracondylar Humerus Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. PMID: 32809768.

13. Joyce KM, Dony A, Whitehouse H et al. (2024). Neurovascular injury from supracondylar fractures in children: a 10-year experience of 762 cases. J Hand Surg Eur. 49(4): 483-489. https://doi.org/10.1177/17531934231201925; PMid:37747700

14. Kanumuri S, Subhansab SK, Agarwal Harding K.J. et al. (2024). Open Exploration and Reduction of Paediatric Supracondylar Humerus Fracture with Pink, Pulseless Hand in Resource-Limited Settings. J Hand Surg Asian Pac. 29(2): 118-124. https://doi.org/10.1142/S2424835524500139; PMid:38494170

15. Liberati A, Altman DG, Tetzlaff J et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 6(7): e1000100. https://doi.org/10.1371/journal.pmed.1000100; PMid:19621070 PMCid:PMC2707010

16. Mannan M, Eisha S, Afridi A. (2024). A Comparison of Nerve Injury in Cross Versus Lateral Pinning Fixation of Displaced Supracondylar Humerus Fracture. Cureus. 16(9): e70404. https://doi.org/10.7759/cureus.70404

17. Özcan M, Altinöz Ö, Erem M et al. (2020). Prognosis and Risk Factors of Nerve Injuries in Displaced Pediatric Supracondylar Humerus Fractures. Nigerian Journal of Clinical Practice. 23(5): 647-653. https://doi.org/10.4103/njcp.njcp_575_18; PMid:32367871

18. Phan MDM, Tran QN, Vo NQD et al. (2024). Treatment of Pink Pulseless Hand Following Supracondylar Fractures of the Humerus in Children. J Hand Surg Asian Pac Vol. 29(6): 554-560. https://doi.org/10.1142/S2424835524500462; PMid:39544037

19. Sabharwal S, Margalit A, Swarup I et al. (2020). The Pulseless Supracondylar Elbow Fracture: A Rational Approach. Indian J Orthop. 55(1): 47-54. https://doi.org/10.1007/s43465-020-00273-6; PMid:33569098 PMCid:PMC7851213

20. Santos IA, Cruz MAF, Souza RC, Barreto LV da F, Monteiro AF, Rezende LGRA. (2024). Epidemiology of Supracondylar Fractures of the Humerus in Children. Archives of health investigation. 13(1): 18-23. https://doi.org/10.21270/archi.v13i1.6324

21. Schädlich IS, Buschbaum S, Magnus T, Reinshagen K, Wintges K, Gelderblom M. (2024, Dec). Median nerve lesions in pediatric displaced supracondylar humerus fracture: A prospective neurological, electrodiagnostic and ultrasound characterization. Eur J Neurol. 31(12): e16459. Epub 2024 Sep 4. https://doi.org/10.1111/ene.16459; PMid:39230443 PMCid:PMC11555132

22. Shore BJ, Gillespie BT, Miller PE et al. (2019). Recovery of motor nerve injuries associated with displaced, extension-type pediatric supracondylar humerus fractures. J Pediatr Orthop. 39: 652-656. https://doi.org/10.1097/BPO.0000000000001056; PMid:31503220

23. Štichhauer R, Preis J, Plánka L et al. (2022). Strategy of pulseless pink supracondylar humerus fracture treatment in children: a comparison of two approaches. Eur J Trauma Emerg Surg. 48(5): 3785-3791. https://doi.org/10.1007/s00068-021-01794-x; PMid:34585254

24. Tomaszewski R, Pethe K, Kler J et al. (2022). Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children – A Retrospective Study. Children. 9: 308. https://doi.org/10.3390/children9030308; PMid:35327679 PMCid:PMC8946881

25. Toğaç S, Eken G, Ermutlu C et al. (2022). Forearm Compartment Pressure Change in Children Operated for Supracondylar Humerus Fracture. J Pediatr Orthop. 42(9): 509-515. https://doi.org/10.1097/BPO.0000000000002220; PMid:35980756

26. Wilks DJ, Ye X, Biggins R et al. (2023). Median Nerve Palsy in Pediatric Supracondylar Humerus Fractures Recovers Faster With Open Than Closed Reduction. J Pediatr Orthop. 43(7): 407-413. https://doi.org/10.1097/BPO.0000000000002424; PMid:37193652

27. Wu JP, Lu YT, Wei XX et al. (2024). Epidemiological characteristics and distribution of pediatric supracondylar fractures in South China: a retrospective analysis of 760 cases. J Pediatr Orthop B. 33(2): 136-141. https://doi.org/10.1097/BPB.0000000000001089; PMid:37129032 PMCid:PMC10829903

28. Xie LW, Wang J, Deng ZQ. (2021). Treatment of pediatric supracondylar humerus fractures accompanied with pink pulseless hands. BMC Musculoskelet Disord. 22(1): 26. https://doi.org/10.1186/s12891-020-03877-z; PMid:33407334 PMCid:PMC7786958