The purpose of this study was to determine the outcome of patients with a supracondylar fracture and an absent radial pulse. All children with displaced extension-type supracondylar fractures from 1984-1992 were eligible. Of 326 children with supracondylar fractures, 22 had an absent radial pulse on admission. Fifteen of the 22 children had a well-perfused hand after closed reduction and K-wire fixation. Five had no pulse but a well-perfused hand after reduction and immobilization of the elbow in slight flexion; none had any problem at final review. Seven patients who had a cold white hand after closed reduction received open reduction of fracture and arterial exploration. In conclusion, the initial treatment for children with displaced supracondylar fractures with an absent radial pulse should be closed reduction, K-wire fixation, and immobilization in < 90 degrees of flexion. Children who have a well-perfused hand but an absent radial pulse after satisfactory closed reduction do not necessarily require routine exploration of the brachial artery.