According to the Gartland classification, a supracondylar fracture of the humerus with complete displacement but with the proximal fragment not piercing the skin belongs to which grade?

Explanation

## Gartland Classification of Supracondylar Fractures **Key Point:** The Gartland classification is the most widely used system for grading supracondylar fractures of the humerus based on the degree of displacement and cortical contact. ### Gartland Grades | Grade | Description | Cortical Contact | Displacement | Prognosis | |-------|-------------|------------------|--------------|----------| | I | Undisplaced or minimally displaced | Intact | <2 mm | Excellent; low complication rate | | II | Displaced with intact posterior cortex | Posterior cortex intact | Anterior angulation | Good; reduction usually stable | | III | Completely displaced; no cortical contact | No cortical contact | Complete displacement | Guarded; high complication risk | | IV | Complete displacement with rotation | No cortical contact | Rotational component | Poor; highest complication rate | **High-Yield:** Grade III is defined by **complete displacement with loss of all cortical contact** between proximal and distal fragments. The key distinguishing feature from Grade II is the absence of any cortical continuity. ### Clinical Implications 1. **Grade I–II:** Often managed conservatively with immobilization; closed reduction may be attempted 2. **Grade III–IV:** Require operative fixation (percutaneous pinning or open reduction) due to high risk of: - Neurovascular injury - Compartment syndrome - Loss of reduction - Malunion with cubitus varus or valgus deformity **Clinical Pearl:** The distinction between Grade II and Grade III is critical: Grade II retains posterior cortical contact ("hinge"), allowing some inherent stability, whereas Grade III has complete loss of cortical contact, making it unstable and requiring operative intervention. **Mnemonic:** **GCS** = **G**artland **C**ortical **S**tatus - Grade I: Cortex intact - Grade II: Posterior cortex intact (hinge) - Grade III: **No cortex intact** (complete displacement) - Grade IV: No cortex + rotational deformity