Supracondylar fracture - Gartland type I

Case contributed by Leonardo Lustosa

Presentation

Fall onto the outstretched hand. Swollen elbow upon physical examination.

Patient Data

Age: 6 years
Gender: Female

Radiographs revealed a minimally (<2 mm) displaced supracondylar fracture of the humerus, in keeping with a Gartland type I supracondylar fracture. The posterior cortex is intact.

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

Anterior humeral line

Annotated image

The anterior humeral line was assessed and identified as intersecting the anterior third of the capitellum ossification center, which in children older than 4 usually represents an indirect sign of displacement.

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 not 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, the capitellum, radial head, and medial epicondyle ossification centers are visible, which is normal given the patient's age.

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