In a child with a supracondylar humerus fracture, which finding indicates a possible brachial artery injury requiring urgent vascular assessment?

• A. Pulseless hand
• B. Normal capillary refill
• C. Mild elbow swelling
• D. Pain with heat at elbow

Answer: (A)

In a supracondylar humerus fracture, the brachial artery can be injured and cut off blood flow to the forearm and hand. The finding that signals a probable arterial injury needing urgent vascular assessment is a pulseless hand. Loss of distal pulse means perfusion to the hand is compromised, which can lead to ischemia if not addressed quickly. This is a true emergency requiring prompt vascular evaluation, possible imaging, and often surgical consultation to restore or protect blood flow.

Normal capillary refill would suggest preserved perfusion, so it does not indicate arterial injury. Mild elbow swelling is common after a fracture and by itself does not show vascular compromise. Pain with heat at the elbow is not a marker of arterial injury.