Classification of supracondylar fractures
The Gartland classification of supracondylar fractures of the humerus is based on the degree and direction of displacement, and the presence of intact cortex. It applies to extension supracondylar fractures rather than the rare flexion supracondylar fracture.
Classification
- type I: undisplaced or minimally displaced
- Ia: undisplaced in both projections
- Ib: minimal displacement, medial cortical buckle, capitellum remains intersected by anterior humeral line
- type II: displaced but with intact cortex
- IIa: posterior angulation with intact posterior cortex; anterior humeral line does not intersect capitellum
- IIb: rotatory or straight displacement but fracture remains in contact
- type III: completely displaced
- IIIa: complete posterior displacement with no cortical contact
- IIIb: complete displacement with soft tissue gap (i.e. bone ends held apart by interposed soft tissues)
- type IV (it was not described in the original Gartland classification and is diagnosed intra-operatively): displaced, with periosteal disruption, unstable in flexion and extension
Practical points
While the fracture type is not usually explicitly detailed in radiological reports, description of the fracture should include the degree and direction of displacement as well as whether the cortex is involved, e.g. none, buckle or break. Ultimately, the injury type determines treatment.
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