Gartland type III fractures are highly correlated with primary neurovascular lesions [
11‐
14]. Posteromedial displacement is associated with radial nerve injuries, whereas posterolateral displacement is associated with median nerve injuries. Brachial artery injuries occur in both types of displacement equally [
15,
16]. Typical vascular injuries are intimal tear, thrombus formation, and division or spasm of the vessel [
17,
18]. The initial therapy of pediatric supracondylar fractures with an absent radial pulse and a cold white hand is closed reduction and fixation with K-wires. If the initial attempt is unsuccessful in restoring the pulse, open reduction and vascular exploration is mandated [
19]. Management of children with absence of their radial pulse with a well-perfused hand is still controversial [
19‐
21]. Remarkably, no difference between early surgical treatment (8 hours or less following injury) and delayed surgical treatment (more than 8 hours following injury), with regard to the perioperative complication rates, is reported [
22]. Due to serious primary neurovascular lesions and difficult physical examination in young patients, a standardized neurovascular assessment has already been proposed [
9]. In the current literature, only a few reports about delayed neurovascular complications exist [
23‐
25]. In fact, an excellent clinical long-term outcome can be expected if postoperative circulatory failure is treated immediately [
24]. In general, artery entrapment syndromes, for example caused by a humeral bony spur, are usually clinically unapparent and symptoms only occur with specific movements, such as extension or flexion of the elbow [
26,
27]. Arguably, a thorough postoperative neurovascular assessment with fully flexed as well as fully extended elbow can detect a postoperative artery entrapment.