Background: Arterial damage is sometimes associated with supracondylar fractures of the humerus. Diagnosis and careful management of the fracture and arterial repair is crucial. Objectives: The aim of this study was to determine the prevalence and outcome of supracondylar fractures of the humerus with signs and symptoms of limb ischemia, before and after arterial decompression or arterial reconstruction. Materials and Methods: From September 2004 to July 2010, 225 consecutive patients with supracondylar fracture of the humerus were prospectively recruited. Results: From among 75 cases with Gartland type III fractures, 22 were found to have vascular injury.. Of the 22 cases with vascular injury, 7 patients underwent arterial reconstruction. The other 15 received arterial decompression. All patients had a satisfactory outcome. Conclusions: A high level of suspicion and careful clinical evaluation leading to an early diagnosis and management of vascular injury accompanying supracondylar fracture is very important to prevent unnecessary sequelae ranging from limb claudication, and compartment syndrome to more severe complications like Volkmann’s contracture and even limb loss.