Retrospective surgical outcomes of Gartland type III supracondylar humeral fractures with absent pulse in children

Introduction – Supracondylar humeral fractures are the most common elbow injuries in children. Gartland type III fractures require urgent treatment due to the high risk of neurovascular injury. Vascular compromise occurs in 5%–15% of cases, most commonly involving the brachial artery, and clinical presentation ranges from complete ischemia (“cold, pale hand”) to the “pink pulseless hand” (PPH). Materials and methods – Twelve children (9 males, 3 females) with Gartland type III supracondylar humeral fractures and absence of a palpable radial pulse, treated between April 2023 and September 2025, were retrospectively analyzed. All patients underwent open reduction and pin fixation within 12 h of injury. Vascular management was guided by limb perfusion: ischemic limbs underwent urgent vascular exploration, whereas patients with PPH were managed with close clinical and instrumental monitoring. Outcomes were assessed using Flynn criteria. Results – The mean age was 5.75 ± 2.38 years, with a mean follow-up of 6 ± 4 months. Ten patients presented with ischemia and underwent vascular exploration, while two patients with PPH were managed without vascular intervention. Although overall outcomes were satisfactory, angular deformities occurred in 50% of patients (three varus, three valgus), and only 50% achieved an excellent Flynn result. Complications included anterior interosseous nerve neuropraxia (two cases), brachial artery thrombosis (one case), and compartment syndrome (one case). Comparisons between groups were exploratory and did not reach statistical significance. Conclusion – Management should be guided by limb perfusion rather than pulse status alone. Patients with preserved perfusion may be safely observed, whereas ischemic limbs require urgent intervention. These injuries should be considered within a neurovascular spectrum. Given the small sample size and short follow-up, findings are descriptive and require confirmation in larger studies.