Abstract
Purpose of the study: To analyse the ability of Blount’s technique (closed reduction and immobilisation with a collar and cuff sling) for the treatment of completely displaced extension-type (Gartland III) supracondylar fracture of the humerus in children.
Introduction: Blount’s technique is usually considered to be unreliable for completely displaced extension-type supracondylar fracture of the humerus. According to the literature, it increases the risks of secondary displacement and neurovascular complications. Consequently, many authors prefer traction or internal fixation with K-wires. Nevertheless, some authors stated that Blount’s technique can be efficient in selected cases of type-III fractures. As we usually used Blount’s technique in our Institution even in cases of type-III fractures we decided to analyse our results.
Material and method: we evaluated retrospectively 46 consecutive cases of completely displaced supracondylar fractures of the humerus treated in our Institution. Mean age was 7 years (3–11). There were 31 left side and 15 right side, 35 males and 11 females. 7 patients who had associated fracture of the forearm or neurovascular damage were treated surgically and stabilised with pins. In 39 patients where the fracture was isolated without initial neurovascular complication, closed reduction under general anesthesia and stabilization with a collar according to Blount’s technique was first attempted. Results: Among the 39 patients where Blount’s technique was used, external reduction failed in 8 cases (in 5 cases, the reduction was not satisfactory, and in 3 cases, the reduction was unstable). These 8 patients were operated during the same anesthesia. Reduction and stabilisation was achieved by open reduction and pinning. Among the remaining 31 patients where closed reduction and external stabilisation could be achieved, we did not note any neurovascular complication or compartment syndrome. 8 days postoperatively, secondary displacement was noted in 2 patients. These 2 patients had operative treatment. The 29 remaining patients were reviewed with a mean follow-up of 29 months (2–6 years). Consolidation was obtained between 30 and 45 days in all cases. At the final follow-up, according to Flynn’s overall modified classification, the clinical result was considered to be excellent in 26 patients and good in 3 patients where a 10° limitation of flexion was noted. The carrying angle was identical to the controlateral side in all cases. Radiographic assessment using Baumann angle was normal in all 29 cases (65° to 75°).
Conclusion: Blount’s technique can be used in selected cases of completely displaced extension-type supracondylar fractures of the humerus in children. It appears to be safe and reliable if a perfect and stable initial reduction can be obtained.
Local Host: British Society for Children’s Orthopaedic Surgery. Conference Theme: Congenital Deficiencies of the Lower Limb. These abstracts were prepared by A.Catterall.
