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Gartland Type-IV Supracondylar Humeral Fractures: Preoperative Radiographic Features and a Hypothesis on Causation
Francisco Soldado1, Felipe Hodgson2, Sergi Barrera-Ochoa1
1Pediatric Hand Surgery and Microsurgery. Barcelona Children's University Hospital HM Nens, Barcelona, Spain.
Background:
The diagnose of Gartland Type-IV (G-IV) supracondylar humeral fractures (SCHF) has been reported to only be possible via fluoroscopy intra-operatively.
Hypothesis:
A preoperative radiographic fracture pattern can indicate a G-IV SCHF.
Patients And Methods:
Retrospective qualitative analysis of radiographs and reduction techniques used in twenty-seven GIV SCHF.
Results:
Anterior-posterior radiographs demonstrated lateral translation or angulation in 21 cases (valgus type) and medial translation or angulation in 6 cases (varus type). In spite of a complete cortical disruption, lateral radiographs showed that the distal fragment was vertically aligned with the proximal fragment. Reduction was achieved in semi-extension, via supination in valgus type fracture and pronation for varus type fractures.
Discussion:
Our conjecture is that a trauma vector in the coronal plane would result in a near-circumferential periosteal disruption, with which either a medial or lateral periosteal hinge remains. The distal fragment would be vertically aligned in lateral radiographs.
Level Of Evidence:
IV; Diagnostic.
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