A 6-year-old child presents with a completely displaced supracondylar humerus fracture (Gartland Type III) with absent radial pulse but warm pink hand and cap refill < 2 seconds (the 'pink pulseless hand'). The MOST appropriate management is:

• A Immediate vascular exploration and brachial artery repair before fracture reduction
• B Urgent closed reduction and percutaneous K-wire fixation followed by reassessment of vascular status ✓
• C Open reduction, internal fixation with plating, and brachial artery exploration
• D Above-elbow cast application and overnight observation of vascular status

Explanation

The 'pink pulseless hand' following supracondylar humerus fracture represents anterior interosseous nerve function intact and adequate collateral circulation maintaining tissue perfusion — the radial pulse is absent because the brachial artery is kinked or in spasm around the fracture, not transected. In this situation, urgent closed reduction and percutaneous K-wire fixation (CRPP) is performed first; fracture reduction frequently restores arterial continuity by releasing the kink. Post-reduction, the radial pulse returns in 60–70% of cases. Only if the hand remains pulseless after anatomical reduction should vascular exploration be considered.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.