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Use of the Gartland classification system for treatment of pediatric supracondylar humerus fractures

Gregory Mallo1, Scott J C Stanat, John Gaffney

  • 1Department of Orthopedics, Stony Brook University Hospital, HSC T-18, Room 089, Stony Brook, NY 11794-8181, USA. gregory.mallo@gmail.com

Orthopedics
|January 9, 2010
PubMed

Insights

Pediatric supracondylar humerus fractures are common. The Gartland classification shows moderate to full agreement among surgeons for classifying these elbow injuries, guiding treatment decisions.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Radiographic Interpretation

Background:

  • Extension-type pediatric supracondylar humerus fractures represent a significant cause of pediatric elbow trauma hospitalizations.
  • The Gartland classification system is the standard for managing these fractures, differentiating treatment based on injury type (Type I: cast immobilization; Types II & III: operative intervention).
  • Previous studies report moderate to full interobserver reliability for the Gartland classification, comparable to other established systems.

Purpose of the Study:

  • To evaluate the interobserver and intraobserver reliability of the Gartland classification system in classifying pediatric supracondylar humerus fractures.
  • To assess the consistency of treatment recommendations (cast immobilization vs. operative intervention) based on Gartland classification.

Main Methods:

  • Four fellowship-trained pediatric orthopedic surgeons reviewed radiographs of 72 pediatric supracondylar humerus fractures.
  • Surgeons classified fractures using the Gartland system and recommended treatment (casting or closed reduction and pinning).
  • Interobserver and intraobserver reliability were statistically analyzed.

Main Results:

  • Moderate agreement was observed when comparing all fractures and specifically Type I and Type II fractures.
  • Full agreement was achieved for Type III fractures among the surgeons.
  • Intraobserver reliability demonstrated full agreement across all classifications.
  • Treatment recommendations differed in 35% of cases based on fracture classification.

Conclusions:

  • The Gartland classification demonstrates moderate to full reliability for pediatric supracondylar humerus fractures, particularly for Type III injuries.
  • While classification reliability is generally good, variations in treatment recommendations highlight potential areas for improved consensus in managing these common pediatric elbow fractures.

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