A 6-year-old child falls on an outstretched hand and sustains a Gartland type III supracondylar fracture of the humerus. The radial pulse is absent but the hand is warm, well-perfused, and pink. Which is the MOST appropriate immediate management?
- A Emergency vascular surgery exploration before ORIF
- B Brachial artery Doppler and CT angiography before any orthopaedic intervention
- C Immediate closed reduction and percutaneous K-wire fixation; monitor vascular status intraoperatively ✓
- D Long arm cast in 90° flexion and observation for 24 hours
Correct answer: C. Immediate closed reduction and percutaneous K-wire fixation; monitor vascular status intraoperatively
Explanation
In a Gartland III supracondylar fracture with a 'pink pulseless hand' (absent pulse but perfused hand), the current consensus is urgent closed reduction and percutaneous K-wire fixation first. Reduction usually restores vascular patency because the brachial artery is kinked/entrapped by the fracture rather than transected. Vascular exploration is added only if perfusion remains poor after anatomical reduction. Casting without fixation is inadequate for type III; pre-reduction angiography wastes critical time.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.