Subclassification of Gartland extension-type II paediatric humerus supracondylar fracture using additional characteristics of breach of anterior cortex, presence of medial comminution and disruption of the hourglass minimizes unnecessary surgery

Introduction: There remains controversy in the management of Gartland Type II fractures. This study reviews the outcome and significance of stability parameters in deciding fracture stability for Gartland Type II fractures and hence suitability for conservative treatment. Methods: This is a retrospective observational cohort study involving children presenting to the Emergency Department between January and October 2017 with a diagnosis of supracondylar humerus fractures (SCHF). We obtained 142 patients (34 operative and 108 non-operative), recording their demographics, circumstances of injury, and X-ray findings for those with Gartland Type II extension type SCHF. Radiological outcomes were assessed using the anterior humeral line and Baumann's angle. We also assessed the fracture characteristic which may contribute to instability. Data were analysed using SPSS Statistics Version 26. Results: We analysed 142 children with a mean age of 5.7 years old (SD ± 2.5). Significant parameters included: breach of anterior cortex, presence of medial comminution and disruption of the hourglass configuration (p = 0.001, p<0.001, and p = 0.004 respectively). There was no difference in malunion, defined using either an abnormal anterior humeral line (11/34 or 32.4% vs 45/108 or 41.7%, p = 0.422) or the Baumann's angle (mean angle 75.2° vs 73.9°, p = 0.244). Conclusions: Subclassification of Gartland extension-type II paediatric humerus supracondylar fracture using additional characteristics of breach of anterior cortex, presence of medial comminution and disruption of the hourglass allows a more accurate assessment of fracture stability. Hence avoiding and minimising unnecessary surgery.