Gartland Type-IV Supracondylar Humeral Fractures: Preoperative Radiographic Features and a Hypothesis on Causation - 22/09/21

Doi : 10.1016/j.otsr.2021.103049

Francisco Soldado ^a, Felipe Hodgson ^b, Sergi Barrera-Ochoa ^a, Paula Diaz-Gallardo ^a, Maria Cristina Garcia-Martinez ^a,^c,⁎ , Tomas R. Ramirez-Carrasco ^d,^e, Pedro Domenech-Fernandez ^f, Jorge Knorr ^c
^a Pediatric Hand Surgery and Microsurgery. Barcelona Children's University Hospital HM Nens, Barcelona, Spain
^b Orthopedics and Traumatology Department. Pontificia Universidad Católica de Chile, Santiago (UC), Chile
^c Hospital Vithas San Jose, Vitoria, Spain
^d Pediatric Orthopedic surgery. Hospital Universitari Vall Hebron. Universitat Autònoma de Barcelona, Barcelona, Spain
^e Pediatric Orthopedic Surgery. Hospital Guillermo Grant Benavente, Universidad de Concepción, Chile
^f Pediatric Orthopedic Surgery. Hospital Universitari i Politècnic La Fe, Valencia, Spain

^⁎Corresponding author at: Hospital Vall d’Hebron, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain.Hospital Vall d’HebronPasseig de la Vall d’Hebron, 119-129Barcelona08035Spain

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 22 September 2021
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Abstract

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.