Gartland classification

Gartland Classification is a system used to categorize the severity of supracondylar fractures of the humerus in children. This classification is instrumental in guiding the treatment and predicting the outcome of these fractures. Supracondylar fractures are among the most common elbow injuries in the pediatric population, and their management is crucial to prevent potential complications, including nerve injury, vascular injury, and malunion.

Overview

The Gartland Classification system was introduced by Dr. James R. Gartland in the 1950s. It categorizes supracondylar fractures based on the extent of fracture displacement and the integrity of the posterior cortex of the humerus. Understanding this classification is essential for orthopedic surgeons, emergency medicine physicians, and other healthcare professionals involved in the care of children with elbow injuries.

Classification

The Gartland Classification is divided into three main types, with a later addition of a subtype to Type III:

• Type I: These are nondisplaced fractures where the bone is cracked but remains in its correct position. There is no disruption of the posterior cortex, and the fracture is stable. These fractures are often treated conservatively with immobilization.

• Type II: These fractures are partially displaced, with the anterior cortex intact but the posterior cortex disrupted. There is a hinge-like movement at the fracture site, but some contact between the fracture fragments remains. Treatment typically involves closed reduction and casting, although some cases may require percutaneous pinning to ensure stability.

• Type III: This category includes completely displaced fractures with no cortical contact between the distal and proximal fragments. These fractures are unstable and require surgical intervention for proper alignment and stabilization, usually through closed reduction and percutaneous pinning.

• Type III (Subtype): Some classifications add a subtype to Type III to describe fractures with significant rotational displacement, which are particularly challenging to treat and may have a higher risk of complications.

Treatment and Prognosis

The treatment of supracondylar humerus fractures depends on the Gartland classification. Type I fractures can often be managed with simple immobilization in a cast, while Type II and III fractures usually require more aggressive intervention to realign and stabilize the bone fragments. The prognosis is generally good with appropriate treatment, but complications can occur, especially with more severe fractures. Early and accurate classification is crucial to guide treatment and minimize the risk of long-term sequelae.

Complications

Complications of supracondylar fractures can include nerve damage, vascular injury, compartment syndrome, and malunion or nonunion of the fracture. The risk of complications increases with the severity of the fracture, underscoring the importance of the Gartland Classification in the initial assessment and management of these injuries.

Conclusion

The Gartland Classification of supracondylar humerus fractures is a fundamental tool in pediatric orthopedics, aiding in the diagnosis, treatment planning, and prognosis of these common injuries. By categorizing fractures based on their anatomical and biomechanical characteristics, this classification system helps clinicians provide targeted and effective care to young patients with elbow fractures.