Outcome of Gartland type II and type III supracondylar fractures treated by Blount’s technique

Abstract

Background:According to some orthopedic surgeons, almost all supracondylar humerus fractures should be treated operatively by reduction and pinning. While according to others, closed reduction and immobolization should be used for Gartland type II and some type III fractures. However, the limit of this technique remains unclear. We present 74 patients with displaced extension-type supracondylar fractures treated by closed reduction and immobilization with a collar sling fixed to a cast around the wrist. The purpose of the study is to give a more precise limitation of this technique.Materials and Methods:Retrospective data acquisition of 74 patients with a Gartland type II or type III fractures treated by closed reduction and immobilization (Blount's technique) between January 2004 and December 2007 was done. The mean age was 6.3 years (range, 2–11). The mean time of follow-up was 6.5 months (range, 3–25). All open injuries and complex elbow fracture dislocations or T-condylar fractures were excluded from the study. All patients were evaluated with standardized anteroposterior and true lateral x-rays of the elbow, and Flynn criteria were used for functional assessment.Results:Gartland type II fractures had 94% good or excellent final results. Gartland type III fractures had 73% good or excellent final result. The Gartland type III outcome depended on the displacement. The fractures remained stable in 88% for the posterior displacement, and 58% for the posteromedial displacement. These displacements were mild. However, for the posterolaterally displaced fractures, only 36% were stable; 36% had a mild displacement and 27% had a major displacement.Conclusion:Pure posterior displacement is more stable than posteromedial displacement which is more stable than posterolaterally displaced fractures. This study suggests that Gartland type II and pure posterior or posteromedial displaced Gartland type III fractures can be treated by closed reduction and immobilization with success.

Outcome of displaced supracondylar fractures in children after manipulation and backslab

“…They include immobilisation in an above-elbow backslab or even collar and cuff for undisplaced fractures (Gartland I). In displaced fractures (Gartland II and III) cast immobilisation in either flexion or extension, [3][4][5][6][7][8][9] various forms of traction, including horizontal traction, vertical traction, Dunlop traction, 3,6,[10][11][12][13] skeletal traction through an olecranon pin and traction in pre-fabricated braces have been used. 3,6,14,15 The commonly accepted method involves closed reduction and Kirschnerwire (K-wire) fixation, with variation in number of pins and configuration, either medial and lateral wires or only lateral wires, which can be either parallel or crossed.…”

Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe?

“…Results of type III were influenced by the direction of displacement: fractures remained stable in 88% of posterior displacements, 58% of posteromedial displacements, and only 36% of posterolateral displacements. 9 Kinkpé et al observed 100% stable fractures and 100% good results in 67 type III fractures. Time to treatment (mean time to referral, 30 hours; mean time to treatment, 46 hours) did not influence anatomic and clinical results.…”

Type - III supracondylar fracture of humerus effectively managed by closed reduction and pop application: A Case Report

“…Some prefer closed reduction and pinning for all displaced supracondylar fractures, including Gartland type II and type III. [4,7] while many agree with open reduction techniques and that type III fractures with a posterolateral displacement are less stable and should be treated by internal fixation 8 .Surgical indications are unsuccessful closed methods, severe displacement, severe ecchymosis in anterior part of elbow, vascular insufficiency and open fractures 6 . Complications are common.…”