According to the Gartland classification, a Type III supracondylar fracture of the humerus is characterized by which displacement pattern?

Explanation

## Gartland Classification of Supracondylar Fractures **Key Point:** The Gartland classification is the most widely used system for supracondylar fractures and is based on the degree of displacement and cortical contact between fragments. ### Gartland Classification System | Type | Displacement | Cortical Contact | Stability | Treatment | |------|--------------|------------------|-----------|----------| | Type I | Minimal/none | Intact posteriorly | Stable | Immobilization (collar & cuff, sling) | | Type II | Displaced | Posterior cortex intact | Relatively stable | Closed reduction + percutaneous pinning | | Type III | Completely displaced | No cortical contact | Unstable | Closed reduction + percutaneous pinning (or open reduction if needed) | ### Type III Supracondylar Fracture Characteristics 1. **Complete displacement** of the distal fragment 2. **Loss of all cortical contact** between proximal and distal fragments 3. **Severe angulation and rotation** (often posteriorly and medially displaced) 4. **High risk of neurovascular compromise** 5. **Unstable fracture** requiring surgical fixation **High-Yield:** Type III fractures account for approximately 50–60% of all supracondylar fractures and have the highest rates of complications (nerve injury, vascular injury, malunion). ### Management Implications - **Immediate:** Neurovascular assessment, ice, elevation, analgesia - **Definitive:** Closed reduction under general anesthesia followed by percutaneous pinning (2–3 K-wires) or open reduction if closed reduction fails - **Monitoring:** Serial neurovascular checks, radiographic confirmation of reduction **Mnemonic:** **GCS for Gartland** — **G**rade I (Good, minimal), **C**omplete loss in Type III, **S**evere displacement in Type III. **Clinical Pearl:** The presence of a "pucker sign" (dimpling of skin over the fracture site) in Type III fractures suggests buttonholing of soft tissues and may necessitate open reduction.