Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all paediatric elbow fractures [Wilson MJ, Hunter JB. Supracondylar fractures of the humerus in children--wire removal in the outpatient setting. Injury Extra 2006 Aug;37(8):313-315] and are often complicated by neurovascular injury. Much confusion surrounds the management of the child with a "pink pulseless hand" post-fracture reduction and several treatment options have been proposed including observation, immediate exploration and angiography. The literature contains a number of case series with variable follow-up. Both angiography and colour duplex ultrasound provide little benefit in the management of these patients. A child with a pink pulseless hand post-fracture reduction can be managed expectantly unless additional signs of vascular compromise develop, in which case exploration should be undertaken.