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Can type IV supracondylar fractures be predicted preoperatively?

Asked by Anonymous 

Type-IV extension type supracondylar fractures are diagnosed in the operating room (during reduction attempt[s]/manipulation), where instability can be assessed without impediments to flexion or extension, as opposed to preoperative radiographic diagnosis, which is possible for fracture types I to III. These are the fractures with circumferential loss of perisoteal hinge leading to instability of fracture in both the flexion and extension.

A study found that the diagnosis of type IV supracondylar fractures was significantly more likely in following cases:
1. Valgus angulation of the distal fragment ≥ 17°
2. Flexion angulation ≥ 10° of the distal fragment

Barik S, Singh G, Maji S, Azam MQ, Singh V. Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible? Rev Bras Ortop (Sao Paulo). 2021 Apr;56(2):230-234. doi: 10.1055/s-0040-1722578. Epub 2021 Mar 31. PMID: 33935319; PMCID: PMC8075635.

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