Description
In this informative presentation, Adelle Fishlock introduces herself and her experience working in Leeds at a major trauma center that deals with numerous referrals for pulseless supracondylar fractures. She emphasizes the importance of complex decision-making beyond simply noting the presence or absence of a pulse, advocating for a thorough neurovascular examination to assess the state of the limb. Fishlock discusses the significance of proper documentation, and she suggests using proformas to ensure comprehensive evaluation of neurovascular status.
The talk delves into when to opt for out-of-hours surgery and outlines critical questions regarding the patient's condition, such as vascular status, soft tissue integrity, and the presence of any other significant injuries. She highlights the need for prompt action in cases of evident soft tissue injury, open fractures, or potential compartment syndrome, illustrating her approach with clinical reasoning.
Fishlock also tackles the contentious issue of managing pink pulseless hands, urging a more nuanced understanding—to determine if this condition indicates a transient vascular spasm or a true arterial injury—and the necessity for individualized patient assessment. Emphasizing the importance of alignment restoration, she notes that this can often lead to pulse recovery and improved limb viability.
Furthermore, she affirms the value of early discussions with vascular or plastic surgeons in cases where arterial problems are suspected, pointing out that many pink pulseless hands may ultimately indicate an underlying brachial artery injury. Fishlock underscores that the management of such patients should follow a coordinated approach across major trauma centers.
Ultimately, the presentation provides a robust framework for assessing and treating supracondylar fractures, underlining the importance of thorough evaluation and collaborative decision-making in trauma care.