![]() Summary of indications for closed reduction percutaneous pinning (CRPP): Philadelphia, PA: Saunders Elsevier 2008. From Herring JA: Tachdjan’s Pediatric Orthopaedics from the Texas Scottish Rite Hospital for Children: 4th ed. Classification of supracondylar fractures of the humerus, as described by Gartland in 1959. The senior author prefers to classify supracondylar fractures as either displaced or undisplaced.įigure 1. 7ĭespite being commonly used descriptively, the Gartland classification is not validated, nor does it clearly guide clinical care. A recent addition to this classification is a Type IV fracture in which the distal fragment is unstable in both flexion and extension due to the loss of the periosteal attachments. Type III injuries can also be further delineated to either posteromedial or posterolateral injuries. 6 Some clinicians distinguish between a Type IIA fracture, which is angulated with an intact hinge of bone, and a Type IIB fracture, which has a complete fracture line with displacement but with the distal fragment still touching the end of the proximal fragment. For example, the Type IA has been described as a truly nondisplaced fracture and the Type IB as a minimally displaced fracture with medial column comminution or varus collapse. There have been several modifications of the Gartland classification over the years. A Type III injury is a completely displaced fragment.A Type II fracture is a displaced fragment with an intact posterior cortex (ie, intact hinge).A Type I fractures is nondisplaced or minimally displaced.Gartland originally classified extension-type fractures, and his system remains the most widely used (Figure 1). More common are the extension-type supracondylar humerus fractures.Flexion-type supracondylar humerus fractures account for only 2% to 5% of these injuries. A flexion supracondylar humerus fracture is when the distal fracture is either flexed, or displaced anteriorly, to the proximal shaft of the humerus.3 Classificationįractures of the supracondylar humerus are first classified as either flexion or extension injuries. ![]() 1,2 A supracondylar fracture of the humerus typically occurs by a fall on an outstretched hand from either furniture (beds, couches, or other objects 3-6 feet high) or playground equipment (monkey bars, slides, or swings). This injury accounts for 50% to 70% of all elbow fractures in children and 3% to 7% of all fractures. A supracondylar humerus fracture is an extra-articular fracture of the distal humerus at the elbow that typically occurs in children between the ages of 5 and 9 years old.
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