Journal of pediatric orthopedics. Part B
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Proximal radioulnar translocation associated with posterior dislocation of the elbow is an extremely rare combination of trauma to the elbow in children. We report on the successful and sequential closed reduction of both these dislocations in a 10-year-old girl in which the translocation of the forearm bones was initially missed. A concomitant fracture would have probably precluded an ideal outcome as we note from the literature review on this problem.
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The management of a persistent pink pulseless hand after a satisfactory closed reduction in a pediatric supracondylar fracture of the humerus is controversial. Several recent publications have recommended vascular exploration in contrast to a more conservative approach accepted traditionally. We report the results of seven patients with a mean follow-up of 36.6 months with a persistent pulseless, but well-perfused hand postreduction. ⋯ A palpable return of the radial pulse was seen in six patients at 3 weeks and at 6 weeks follow-up in the other patient with no long-term dysfunction. We believe that the management of a persistent pink pulseless hand remains a 'watchful expectancy'. Surgical exploration should be recommended only if there is either severe pain in the forearm persisting for more than 12 h after the injury or if there are signs of a deteriorating neurological function.