Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible?

Sitanshu Barik; Gobinder Singh; Subhajit Maji; Md Quamar Azam; Vivek Singh

doi:10.1055/s-0040-1722578

Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible?

Rev Bras Ortop (Sao Paulo). 2021 Apr;56(2):230-234. doi: 10.1055/s-0040-1722578. Epub 2021 Mar 31.

Authors

Sitanshu Barik¹, Gobinder Singh¹, Subhajit Maji¹, Md Quamar Azam², Vivek Singh¹

Affiliations

¹ Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia.
² Departamento de Cirurgia de Trauma, All India Institute of Medical Sciences, Rishikesh, Índia.

Abstract

Objectives The present study aims to identify preoperative characteristics of the patient, of the injury, as well as of imaging, which would point towards a type IV fracture. The present study shall help the operating team to predict more accurately the type IV pattern preoperatively, leading to improved counselling of the caregivers, planning of surgery, as well as preparedness regarding open reduction, if such situation arises. Methods A retrospective study was conducted, including patients that met the following criteria: 1) age < 16 years old; 2) Gartland type-III and type-IV supracondylar fractures; and 3) with complete records. Demographic data like age, gender, laterality, mode of injury, hospital duration of the injury, history of previous attempts of closed reduction, open/closed fracture, distal neurovascular status, and radiographic data like angulation, translation, osseous apposition and fracture comminution were collected. Results Hospital duration of the injury and previous attempts of closed reduction were the factors that had a statistically significant difference among types III and IV fractures ( p < 0.05). A diagnosis of type IV supracondylar fractures was significantly more likely in the presence of valgus angulation of the distal fragment ≥ 17° (odds ratio [OR] = 20.22; 95% confidence interval [CI] = 3.45-118.65). Flexion angulation ≥ 10° (OR = 5.32; 95% CI = 0.24-119.88) of the distal fragment predicted Gartland type IV with a sensitivity of 41% and a specificity of 100%. Conclusion The preoperative evaluation of suspected Gartland IV fractures can help the operating surgeon in predicting such injuries. Nonradiographic factors like increased hospital duration of the injury, attempts at previously closed reduction, and radiographic parameters like valgus and flexion angulation were more likely to be associated with type IV fractures. Level of evidence III.

Keywords: child; elbow joint; fracture fixation; humeral fractures.

Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).