Assumptions & Disclaimer for Vascular Injuries Which Are Still Present Postoperatively Sub-AUC:
Before these appropriate use criteria are consulted, it is assumed that:
- A child who presents with a dysvascular limb is triaged in a timely and appropriate manner to a facility capable of handling these issues after an attempt to reposition or reduce the fracture into a more acceptable position to improve vascular status. A formal vascular consult or vascular study should not delay the child undergoing attempted repositioning or reduction of the fracture.
- In the clinical setting of a SCH Fx presenting with non-palpable radial pulse in the ED, a qualified clinician may give consideration to reposition the elbow in slight flexion and reassess whether the pulse returns.
- Regardless of return of pulse (or lack thereof) after repositioning of elbow, the patient should be admitted to the hospital for timely reduction/fixation and observation.
- In the scenario of a pulseless extremity, transfer of the patient to another facility should be considered if no qualified vascular or microvascular surgeon is available at that institution.
- When patient undergoes vascular consultation, consultation should be performed by a clinician with specialized microvascular or vascular training.
CONDITIONS NOT COVERED IN THIS AUC:
- Lateral and medial humeral condylar fractures
- Capitellar fractures
- Any fracture where all the fracture lines are completely above the flare of metaphysis (i.e. diaphyseal humerus fractures)
- Treatment of concomitant injuries accompanying supracondylar fracture, although the influence of these injuries on treatment of the PSHF will be considered.
- Adult pattern distal humerus fractures
Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options