Classification of Supracondylar Fractures
Supracondylar fractures are classified primarily by the Gartland classification system (Types I, II, and III based on displacement) and by mechanism into extension-type versus flexion-type fractures. 1
Primary Classification Systems
Gartland Classification (Extension-Type)
The Gartland classification is the most clinically relevant system for pediatric supracondylar fractures, directly guiding treatment decisions:
- Type I: Nondisplaced or minimally displaced fractures 1
- Type II: Displaced fractures with intact posterior cortex 1
- Type III: Completely displaced fractures with no cortical contact 1
The AAOS guidelines specifically reference Gartland Types II and III when recommending closed reduction with pin fixation for displaced fractures, emphasizing that these types require surgical intervention to prevent complications including cubitus varus deformity and loss of function. 1
Mechanism-Based Classification
Extension-type versus Flexion-type:
- Extension-type: The vast majority of supracondylar fractures (>95%), occurring from fall on outstretched hand 2
- Flexion-type: Rare variant from direct blow to posterior elbow, with anterior displacement of the distal fragment 1
The AAOS guidelines explicitly include "displaced flexion" fractures in their treatment recommendations alongside Gartland Types II and III, indicating these require the same surgical approach with closed reduction and pin fixation. 1
Clinical Significance of Classification
Treatment is directly determined by fracture type:
- Gartland Type I fractures can typically be managed nonoperatively
- Gartland Types II and III require closed reduction with pin fixation (moderate strength recommendation) to avoid limb-threatening complications such as ischemia from hyperflexion casting 1
- Displaced flexion-type fractures follow the same surgical treatment algorithm as extension-type Gartland II/III fractures 1
Important Caveat
The classification system helps predict complications: Gartland Type III fractures have higher rates of neurovascular injury (28.6% nerve palsy rate documented in combined injury patterns) and may require emergent reduction if perfusion is compromised. 2, 1