PMC9647666_01
Preoperative anteroposterior X-ray of the first patient. Note the high degree of obliquity and a very
sharp medial spike. Distal segment of the proximal fragment is marked to better delineate the fragment edges
superposed on proximal radius.
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F1
There was prominent medial spike on the ulnar corner of the proximal fragment, with a medial spike angle of <45 degrees (Figure 1).
Exposure through the antecubital approach. (a) Note the brachial artery with the adventitia entrapped in the cancellous
bone. (b) Deep veins of the arm and median nerve interposed between medial spike and the pierced brachialis muscle. (c) The
adventitia of the brachial artery is freed by scraping the adjacent cancellous bone with the tip of a hemostat. The artery can now
be mobilized so that it will not be impinged during reduction.
B: Brachial artery; V: Deep vein of the arm; M: Median nerve; U: Ulnar side; R: Radial side.
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F2
The brachial artery was kinked and entrapped in the cancellous bone of the proximal fracture segment (Figure 2).
PMC9647666_02
Radiographs of the second case. Supracondylar fracture with a medial spike with angle less than 45 degrees and high
obliquity in the sagittal plane.
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F3
A four-year-old girl had a fracture with high sagittal obliquity (>20 ) which was unstable in all directions (Figure 3). Antecubital approach was used without closed reduction attempt.
PMC9647666_03
Change in the volume of brachial artery after release. (a) A small increase in volume of the thin strip of tissue after
it was freed from the surrounding cancellous bone. (b) Brachial artery and the two venae comitantes became much bulkier and
regained their true volume at the end of the operation.
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F4
The suspected tissue increased in volume, proving that it was a vessel (Figure 4a). At the end of the operation, the initially thin strip of connective tissue had become much bulkier, with palpable pulsation and two venae comitantes, indicating the brachial artery without any doubt (Figure 4b).