Gartland classification

Classification system for supracondylar humeral fractures

The Gartland classification is a system used to categorize supracondylar humeral fractures, which are common injuries in the pediatric population. This classification helps in determining the severity of the fracture and guides the management and treatment approach.

Overview

Supracondylar humeral fractures occur just above the elbow joint and are most frequently seen in children. The Gartland classification system is widely used by orthopedic surgeons to assess these fractures based on the degree of displacement and the integrity of the cortex.

Classification

The Gartland classification divides supracondylar humeral fractures into three main types:

Type I

Gartland Type I fracture

Type I fractures are non-displaced or minimally displaced. The periosteum is intact, and the fracture is stable. These fractures are often managed conservatively with immobilization using a cast or splint.

Type II

Type II fractures are displaced but have an intact posterior cortex. The fracture is angulated, but the periosteum is still partially intact, providing some stability. Treatment typically involves closed reduction and immobilization, although surgical intervention may be necessary if reduction is not satisfactory.

Type III

Type III fractures are completely displaced with no cortical contact. The fracture is unstable, and there is a high risk of neurovascular injury. These fractures usually require surgical intervention, often with percutaneous pinning to achieve and maintain reduction.

Management

The management of supracondylar humeral fractures depends on the Gartland classification:

• Type I: Managed with immobilization in a cast or splint for 3-4 weeks.
• Type II: May require closed reduction under anesthesia followed by casting. If reduction is not stable, surgical fixation may be needed.
• Type III: Typically requires surgical intervention with closed or open reduction and percutaneous pinning.

Complications

Complications of supracondylar humeral fractures can include:

• Volkmann's ischemic contracture due to compromised blood supply.
• Cubitus varus or "gunstock deformity" due to malunion.
• Nerve injury, particularly to the anterior interosseous nerve or the ulnar nerve.

Related pages

• Supracondylar humeral fracture
• Orthopedic surgery
• Pediatric trauma