A 10-year-old boy sustains a Gartland Type III supracondylar fracture of the humerus with a pulseless but well-perfused hand (pink hand). The MOST appropriate next step is:
- A Emergency vascular exploration before fracture fixation
- B Closed reduction and percutaneous K-wire fixation ✓
- C Above-elbow cast with overnight observation
- D Arteriogram to confirm brachial artery injury
Correct answer: B. Closed reduction and percutaneous K-wire fixation
Explanation
A pulseless but pink and well-perfused hand after Gartland III supracondylar fracture indicates intact collateral circulation (radial artery and interosseous arteries maintain perfusion). Current guidelines recommend immediate closed reduction and percutaneous K-wire fixation, which often spontaneously restores arterial flow by decompressing the kinked or spasmed brachial artery. Vascular exploration is reserved for a pulseless cold (white) hand that remains ischaemic after fracture reduction, indicating true arterial injury.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.