According to the Gartland classification, a supracondylar fracture of the humerus with complete displacement but intact cortical contact is classified as which type?

Explanation

## Gartland Classification of Supracondylar Fractures **Key Point:** The Gartland classification is the most widely used system for supracondylar fractures of the humerus and directly guides treatment decisions. ### Gartland Classification System | Type | Displacement | Cortical Contact | Angulation | Treatment | |------|--------------|------------------|------------|----------| | **Type I** | Minimal/no displacement | Intact | Minimal | Closed reduction + immobilization (sling/cast) | | **Type II** | **Complete displacement** | **Intact (posterior cortex)** | Angulated posteriorly | Closed reduction + percutaneous pinning or immobilization | | **Type III** | Complete displacement | No cortical contact | Severe | Closed reduction + percutaneous pinning (CRPP) or open reduction | | **Type IV** | Complete displacement | Unstable in flexion AND extension | Severe | ORIF or CRPP | **High-Yield:** The defining feature of **Type II** is complete displacement of the distal fragment with an **intact posterior cortical hinge** — this cortical bridge provides relative stability and distinguishes it from Type III. ### Clinical Distinction: Type II vs Type III - **Type II:** Distal fragment displaces (typically posteriorly) but the posterior cortex remains in contact → cortical bridge intact → relatively stable → may be managed with closed reduction ± percutaneous pinning - **Type III:** Complete displacement with **total loss of cortical contact** → no bony bridge → highly unstable → requires surgical fixation (CRPP) **Clinical Pearl:** The presence or absence of cortical contact at the fracture site is the critical differentiator between Type II and Type III. This is assessed on AP and lateral X-rays. The stem describes "complete displacement but intact cortical contact," which is the hallmark of **Type II**, not Type III. **Mnemonic:** **"Cortical Contact Counts"** — Type II has it (cortical bridge intact), Type III does not. *Reference: Rockwood & Wilkins' Fractures in Children, 8th ed.; Campbell's Operative Orthopaedics.*