Von Laer classification of pediatric supracondylar humerus fractures

Last revised by Max Sandoval on 12 Jan 2023

The Von Laer classification, also known as the Laer classification, is used to grade the severity and the need for further diagnostic evaluation and surgical correction of pediatric supracondylar humerus fractures, based on their clinical and radiological presentation.

Classification

Von Laer's classification divides supracondylar humerus fractures into four types.

Type I
  • supracondylar humerus fracture without dislocation (stable)

  • elbow radiograph

  • usually presents with light swelling and reduced mobility due to pain

  • no surgical correction is required, only conservative management with cast application

Type II
  • supracondylar humerus fracture with dislocation in the sagittal plane (sometimes unstable).

  • elbow radiograph

    • positive fat pad sign, dorsal displacement of the distal fragment/capitellum

  • moderate-to-severe swelling and pain

  • surgical correction required if dorsal displacement >30°

  • follow-up X-ray in 3-5 days

Type III
  • supracondylar humerus fracture with dislocation in every plane and rotation deformity (unstable)

  • elbow radiograph

    • positive fat pad sign, displacement and rotation of the distal fragment/capitellum

  • further evaluation with Doppler ultrasound to exclude vascular injury is recommended

  • severe swelling and pain, ecchymosis, visible deformity

  • surgical correction via intramedullary nailing, Kirschner wire or external fixation required

Type IV
  • supracondylar humerus fracture with dislocation in every plane, rotation deformity and no contact between fragments (unstable)

  • elbow radiograph

    • positive fat pad sign, displacement and rotation of the distal fragment/capitellum

  • further evaluation with Doppler ultrasound to exclude vascular injury is recommended

  • severe swelling and pain, ecchymosis. If dislocation is severe, S-shaped deformity may be present.

  • surgical correction via intramedullary nailing, Kirschner wire or external fixation required

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