Pediatric emergency medicine trisk 3455 3455
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TABLE 111.5
GARTLAND CLASSIFICATION FOR SUPRACONDYLAR
FRACTURES
Type
Description
Radiographic findings
Type I
Nondisplaced fracture
Type II
Displaced fracture with
intact posterior cortex
Type III
Completely displaced
fracture with no cortical
contact
+ posterior fat pad, “sail
sign”
Anterior humeral line is
anterior to the capitellum,
“hinged” or intact
appearance of the
posterior cortex
Displacement of the distal
fragment relative to the
humeral shaft; fractures
of both cortices
Perfusion assessment includes: skin color and temperature, palpation of
forearm compartments, capillary refill, and pulses (by palpation or Doppler if not
palpable). If the child has a pink, warm hand with good capillary refill, a serious
vascular injury is less likely; by contrast the child with a cold, pale hand with
poor capillary refill is a surgical emergency. Absence of pulses by Doppler even
in the setting of good distal perfusion (e.g., “pink pulseless hand”) is an indication
for emergent orthopedic consultation.
TABLE 111.7
GROWTH CENTERS OF ELBOW: AVERAGE AGE FOR ONSET OF
OSSIFICATION
Capitellum
Medial epicondyle
Trochlea
Olecranon
Lateral epicondyle
11 mo
4–6 yrs
6–8 yrs
9–10 yrs
10–12 yrs
