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

de Gheldere A, Bellan D - Indian J Orthop (2010)

Bottom Line: According to some orthopedic surgeons, almost all supracondylar humerus fractures should be treated operatively by reduction and pinning.The Gartland type III outcome depended on the displacement.Pure posterior displacement is more stable than posteromedial displacement which is more stable than posterolaterally displaced fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedic Surgery, CHU Brabois, Children's Hospital, Rue du Morvan, F-54500, Vandoeuvre les Nancy, France.

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.

No MeSH data available.


Related in: MedlinePlus

Pre-reduction anteroposterior (a) and lateral (b) radiographs of the elbow of a Gartland type-III fracture with pure posterior displacement. Post-reduction radiographs lateral view (c) and anteroposterior (d) view immobilized by collar cuff and cast around the wrist. Lateral (e) and anteroposterior (f) radiograph of the elbow at eight months follow-up
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Figure 0002: Pre-reduction anteroposterior (a) and lateral (b) radiographs of the elbow of a Gartland type-III fracture with pure posterior displacement. Post-reduction radiographs lateral view (c) and anteroposterior (d) view immobilized by collar cuff and cast around the wrist. Lateral (e) and anteroposterior (f) radiograph of the elbow at eight months follow-up

Mentions: A Gartland type III fracture is a displaced supracondylar fracture with no meaningful cortical contact.2 There is a translational and a rotational displacement which can explain the greater lateral rotational percentage. Because of an early loss of reduction, three patients had to be brought back into the operative room for internal fixation. Even if the final Baumann mean angle is good, only 29 out of the 40 patients had good and excellent outcomes. Table 3 analyzes the preoperative displacement of the Gartland type III fracture. Pure posterior displacement fractures (group A) have an intact posterior periosteal hinge. They are easy to reduce and most of them are stable in full flexion with the forearm in a pronation position [Figure 2]. Laterally torn perioteum is associated with a posteromedially displaced fracture (group B). It is also easy to reduce and is more stable in the same position. The pronation position places the medial periosteum on tension, and lateral compressive force closes the lateral edge to avoid varus malalignment.1920 However, a medial periosteum torn is associated with a posterolaterally displaced fracture (group C). Some authors believe that pronation is the most stable position,1920 while others think that the pronation position may be counterproductive and suggest the supination position when the lateral periosteum is intact.2 If the fracture has no periosteum hinge, it becomes unstable in both flexion and extension. This multidirectional instability is known as Gartland type IV.22 These fractures should be treated by internal fixation without any discussion and are not analyzed in this study.


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

de Gheldere A, Bellan D - Indian J Orthop (2010)

Pre-reduction anteroposterior (a) and lateral (b) radiographs of the elbow of a Gartland type-III fracture with pure posterior displacement. Post-reduction radiographs lateral view (c) and anteroposterior (d) view immobilized by collar cuff and cast around the wrist. Lateral (e) and anteroposterior (f) radiograph of the elbow at eight months follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822426&req=5

Figure 0002: Pre-reduction anteroposterior (a) and lateral (b) radiographs of the elbow of a Gartland type-III fracture with pure posterior displacement. Post-reduction radiographs lateral view (c) and anteroposterior (d) view immobilized by collar cuff and cast around the wrist. Lateral (e) and anteroposterior (f) radiograph of the elbow at eight months follow-up
Mentions: A Gartland type III fracture is a displaced supracondylar fracture with no meaningful cortical contact.2 There is a translational and a rotational displacement which can explain the greater lateral rotational percentage. Because of an early loss of reduction, three patients had to be brought back into the operative room for internal fixation. Even if the final Baumann mean angle is good, only 29 out of the 40 patients had good and excellent outcomes. Table 3 analyzes the preoperative displacement of the Gartland type III fracture. Pure posterior displacement fractures (group A) have an intact posterior periosteal hinge. They are easy to reduce and most of them are stable in full flexion with the forearm in a pronation position [Figure 2]. Laterally torn perioteum is associated with a posteromedially displaced fracture (group B). It is also easy to reduce and is more stable in the same position. The pronation position places the medial periosteum on tension, and lateral compressive force closes the lateral edge to avoid varus malalignment.1920 However, a medial periosteum torn is associated with a posterolaterally displaced fracture (group C). Some authors believe that pronation is the most stable position,1920 while others think that the pronation position may be counterproductive and suggest the supination position when the lateral periosteum is intact.2 If the fracture has no periosteum hinge, it becomes unstable in both flexion and extension. This multidirectional instability is known as Gartland type IV.22 These fractures should be treated by internal fixation without any discussion and are not analyzed in this study.

Bottom Line: According to some orthopedic surgeons, almost all supracondylar humerus fractures should be treated operatively by reduction and pinning.The Gartland type III outcome depended on the displacement.Pure posterior displacement is more stable than posteromedial displacement which is more stable than posterolaterally displaced fractures.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedic Surgery, CHU Brabois, Children's Hospital, Rue du Morvan, F-54500, Vandoeuvre les Nancy, France.

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.

No MeSH data available.


Related in: MedlinePlus