According to the Gartland classification, a supracondylar fracture of the humerus with complete displacement but with intact cortical continuity on one side is classified as:

Explanation

## Gartland Classification of Supracondylar Fracture **Key Point:** The Gartland classification is the most widely used system for supracondylar fractures of the humerus. **Type II** represents displacement with intact cortical continuity on one side (the posterior cortex acts as a hinge), distinguishing it from Type III where cortical continuity is lost on both sides. ### Gartland Classification System | Type | Description | Displacement | Cortical Continuity | Stability | | --- | --- | --- | --- | --- | | Type I | Undisplaced or minimally displaced | Minimal/none | Intact on both sides | Stable | | Type II | Displaced with intact posterior cortex | Partial–complete | Intact on one side (posteriorly) | Partially stable | | Type III | Completely displaced | Complete | Lost on **both** sides | Unstable | | Type IV | Displaced with loss of cortical contact in all planes | Complete in all planes | Lost in all planes | Highly unstable | ### Type II Fracture Characteristics - Displacement is present, but **one cortex (typically the posterior cortex) remains intact**, providing a hinge - This intact cortical continuity on one side is the **defining feature** of Type II - The posterior cortical hinge confers partial stability - May be managed with closed reduction ± percutaneous pinning depending on stability after reduction ### Why Not Type III? - Type III fractures have **complete loss of cortical continuity on both sides** — there is no cortical hinge remaining - The stem explicitly states "intact cortical continuity on one side," which rules out Type III **High-Yield:** The key differentiator between Type II and Type III is the **posterior cortical hinge**: present in Type II (intact on one side), absent in Type III (lost on both sides). This distinction drives management — Type II may occasionally be managed conservatively, while Type III almost always requires percutaneous pinning. **Mnemonic:** **GARTLAND** — **G**rade I (undisplaced), **G**rade II (partial displacement, **one cortex intact**), **G**rade III (complete displacement, **both cortices lost**), **G**rade IV (rotational displacement in all planes). ### Clinical Significance - Type I: Closed reduction and immobilization (cast) - Type II: Closed reduction with percutaneous pinning or cast (depending on stability) - Type III & IV: Percutaneous pinning or open reduction internal fixation (ORIF) **Clinical Pearl:** Accurate Gartland typing is critical because it directly guides operative vs. non-operative management. Misclassifying a Type II as Type III may lead to unnecessary surgery, while the reverse error risks inadequate treatment of an unstable fracture. [cite:Rockwood and Green's Fractures in Adults 9e Ch 11; Canale & Beaty: Campbell's Operative Orthopaedics 13e]