Supracondylar fracture - Gartland type I

Case contributed by Leonardo Lustosa

Presentation

Fall onto the outstretched hand while playing on a trampoline.

Patient Data

Age: 9 years
Gender: Female

Elbow radiographs revealed a discrete lucent fracture line on the frontal plane. The lateral radiograph shows an undisplaced supracondylar fracture of the humerus.

These findings describe a Gartland type I supracondylar fracture.

Also, there is a small elbow joint effusion, shown by the sail sign.

Anterior humeral line

Annotated image

The anterior humeral line was assessed and identified as intersecting the middle third of the capitellum ossification center, as it normally should.

Case Discussion

Supracondylar fractures are the most common elbow fractures in children. Fall onto the outstretched hand with the elbow in full extension is the main mechanism of injury.

Gartland type I fractures are undisplaced or minimally displaced supracondylar fractures. Sometimes, fracture lines are difficult to be seen on Gartland type I fractures. In these cases, it is important to look for indirect signs of a supracondylar fracture, such as:

In the present case, there was a small elbow joint effusion. The anterior humeral line was passing through the middle third of the capitellum.

Finally, it's important to be familiar with the elbow ossification centers when assessing a pediatric elbow. In this case, although the trochlear and olecranon ossification centers can be seen, the medial epicondyle ossification center can not, which is unusual, as the latter commonly is seen before the aforementioned ones.

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