![]() Type I injuries are immobilized with a cast for 3 to 4 weeks, with radiographic alignment checked at 1 week. ![]() Treatment of pediatric supracondylar humerus fractures has evolved since Gartland’s first description however, current treatment recommendations from the American Academy of Orthopaedic Surgeons remain based on the modified Gartland classification. In 1963, he reported there may be a role for open reduction of displaced, unstable fractures and stabilization with thin stainless steel wires. For severely displaced fractures, the same algorithm was used, with Gartland noting an increased number of unstable fractures and neurologic and vascular injuries. If radiographs obtained 24 hours later showed residual or recurrent displacement, the fracture was considered unstable, and ulna-based overhead skeletal traction was indicated. For moderate displacement, closed reduction and casting with the patient under general anesthesia was the preferred treatment. He emphasized the importance of a detailed neurologic and vascular examination and cautioned against applying a cast that was too tight or flexing the elbow past 80°. Nondisplaced fractures were to be immobilized in a plaster cast with the forearm flexed 75° to 80° in neutral rotation without manipulative reduction. ![]() Gartland first described a treatment algorithm to allow widespread management of the common but previously misunderstood supracondylar humerus fracture to decrease the incidence of malunion and Volkmann’s contracture. He described three types of extension injury based on degree of displacement: type I, nondisplaced type II, moderately displaced and type III, severely displaced injury, and he considered flexion-type injuries separately. Gartland described a rotatory and translational deformity, with posterior displacement (extension) of the distal fragment occurring most often. Supercondylar humerus fractures occur proximal to the articular surface of the distal humerus and may be transverse, oblique, or jagged. In 1959, Gartland described a simple classification scheme to reemphasize principles underlying treatment of patients with a supracondylar humerus fracture and discussed a method of injury management that has proven to be practical and effective with time. During the 1950s, these injuries were called the “misunderstood fracture,” as such injuries often resulted in bony deformity and Volkmann’s contracture. Supracondylar humerus fractures are the most common elbow injury in pediatric patients.
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