This 2015 Classifications in Brief reviews the Gartland classification of pediatric supracondylar humerus fractures from its 1959 origin through subsequent modifications. It traces how Wilkins, De Boeck, and Leitch refined the system to its current four-type structure and evaluates the classification's reliability and known limitations.
When a child presents with a supracondylar humerus fracture, the single most consequential decision is whether it is Type I or Type II — and the paper shows this is exactly where classifiers disagree most (kappa 0.74 overall, with the I/II boundary driving most errors).
Type IIB is the critical subtype to recognize: posterior cortical contact is maintained, but rotational instability is present. These fractures look deceptively stable on one view and will malunite in a cast. They need pinning.
For neurovascular assessment, use perfusion status rather than pulse presence to decide on vascular exploration. An absent radial pulse alone is common (7–12%) and often resolves with reduction.
When you encounter a nerve injury, counsel the family that 86–100% resolve spontaneously. For extension-type fractures, examine for anterior interosseous nerve function (FPL, FDP to index). For flexion-type fractures, check ulnar nerve function. It is involved in 91% of those cases.
This 2015 Classifications in Brief reviews the Gartland classification of pediatric supracondylar humerus fractures from its 1959 origin through subsequent modifications. It traces how Wilkins, De Boeck, and Leitch refined the system to its current four-type structure and evaluates the classification's reliability and known limitations.
When a child presents with a supracondylar humerus fracture, the single most consequential decision is whether it is Type I or Type II — and the paper shows this is exactly where classifiers disagree most (kappa 0.74 overall, with the I/II boundary driving most errors).
Type IIB is the critical subtype to recognize: posterior cortical contact is maintained, but rotational instability is present. These fractures look deceptively stable on one view and will malunite in a cast. They need pinning.
For neurovascular assessment, use perfusion status rather than pulse presence to decide on vascular exploration. An absent radial pulse alone is common (7–12%) and often resolves with reduction.
When you encounter a nerve injury, counsel the family that 86–100% resolve spontaneously. For extension-type fractures, examine for anterior interosseous nerve function (FPL, FDP to index). For flexion-type fractures, check ulnar nerve function. It is involved in 91% of those cases.