The Significance of an Absent Radial Pulse in Supracondylar Fracture of the Humerus

I HE correct method of treatment of a supracondylar fracture of the humerus with no palpable radial pulse still presents a problem. There is obviously still some doubt as to whether the absent radial pulse should give rise to any alarm, provided the hand is a reasonable colour, and the circulation in it seems to be quite satisfactory. The author feels that it should, and it is the purpose of this paper to encourage others to undertake early exploration and exposure of the brachial artery at the fracture site in these cases. Griffiths (1940) has already made it quite clear that in Volkmann's ischaemic contracture the basic pathology is a necrosis of muscle due to an insufficient supply of arterial blood. This necrosis is an irreversible change, and occurs when the blood supply has been absent for six to eight hours. After that time nothing can prevent the necrotic muscle from being replaced by fibrous tissue and an ischaemic contracture developing. It is therefore clear that if there is a likelihood of such necrosis occurring, and I believe this to be so in all cases where there is no palpable radial pulse, then something must be done within eight hours of the injury. The first step is, of course, to reduce the fracture, as this alone may restore an absent pulse. If this fails, the arm should be extended, if -necessary until it is quite straight. If there is still no pulse, then, no matter how good the circulation in the hand appears, the brachial artery should be explored. Three cases of supracondylar fracture with no radial pulse have been seen in the last two years.