gms | German Medical Science

Objectives: Pink Pulseless Hand (PPH) is characterized by radial pulselessness in a complex of good hand perfusion which can remain pink and warm. The management and treatment of this condition is still very debated.

Methods: We report 4 cases of arm traumas which occurred in pediatric patients at our hospital since June 2016. Four cases were all fall trauma, presenting pucker sign, anterior interosseous nerve paralysis. In all cases, after the fixation of the fracture by the orthopedic surgeon, the clinical evaluation demonstrated the PPH.

Results: We decided to proceed with an immediate surgical exploration and decompression followed by a prompt recovery of the pulsatility. In 2 cases, we found the brachial arteries in spasm, using papaverine improved blood flow well. In 1 case, the blood flow was disrupted, inner membrane injury and thrombus formation were observed, veins were collected from the left lower thigh by diagnosis of brachial artery injury and revascularization was performed. In 1 case showed thrombus formation, and thrombectomy was performed with a fogarty catheter. Postoperative course was uneventful. At 2-year follow-up, the young patients have a normal hand function with no neurovascular damages and regular peripheral signals.

Conclusions: According to the literature, observation is the treatment of choice for many authors. But Blakey et al. reported a long-term outcomes study of 26 patients with PPH who had delayed presentation, 23 had signs of Volkmann's ischaemic fibrosis in the affected lim. And White et al reported brachial arterial injuries could be proven in 70% no return of pulse after closed reduction.2 cases of 4 our patients (50%), presented brachial artery injuries. In addition, reperfusion injury following PPH which treated conservative follow-up has been reported with a frequency of 0-33 %. PPH requires urgent surgical exploration if no return of pulse after closed reduction.