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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.

  1. An article discusses that type IV supracondylar fractures are more likely a problem created intraoperatively, possibly by less experienced surgeons, with the identification of type IV fractures from preoperative radiographs not being reliable.

    Reference: Rehm A, Granger L, Ashby E. Letter to the Editor regarding: "Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible?" Barik S, Singh G, Maji S, Azam Q, Singh V. Rev Bras Ortop 2021;56(2):230-234. Rev Bras Ortop (Sao Paulo). 2022 Feb 15;57(5):896-897. doi: 10.1055/s-0042-1742598. PMID: 36226200; PMCID: PMC9550359.