{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:39:25Z","timestamp":1791823165390,"version":"4.3.4"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2019,8,7]]},"abstract":"\n Background:<\/jats:title>\n Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 \u00b1 42 compared with 63 \u00b1 28 minutes; p = 0.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.18.01178","type":"journal-article","created":{"date-parts":[[2019,8,13]],"date-time":"2019-08-13T14:29:36Z","timestamp":1565706576000},"page":"1351-1356","source":"Crossref","is-referenced-by-count":31,"title":["Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures"],"prefix":"10.2106","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9066-1088","authenticated-orcid":false,"given":"Stuart L.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0072-6891","authenticated-orcid":false,"given":"Brian T.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6710-6040","authenticated-orcid":false,"given":"Christine A.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas"},{"name":"Department of Orthopaedic Surgery, Children\u2019s Medical Center, Dallas, Texas"},{"name":"Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9821-7712","authenticated-orcid":false,"given":"Joshua M.","family":"Abzug","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8167-5808","authenticated-orcid":false,"given":"Micheal","family":"Raad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2934-6374","authenticated-orcid":false,"given":"Paul D.","family":"Sponseller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"5","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.2106\/JBJS.G.01354","article-title":"Supracondylar humeral fractures in children","volume":"90","author":"Omid","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib5-20230810","first-page":"145","article-title":"Management of supracondylar fractures of the humerus in children","volume":"109","author":"Gartland","year":"1959","journal-title":"Surg Gynecol Obstet."},{"issue":"6","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/BPO.0000000000000344","article-title":"The outcome of surgical treatment of multidirectionally unstable (type IV) pediatric supracondylar humerus fractures","volume":"35","author":"Silva","year":"2015","journal-title":"J Pediatr Orthop."},{"issue":"5","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"980","DOI":"10.2106\/JBJS.D.02956","article-title":"Treatment of multidirectionally unstable supracondylar humeral fractures in children. 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The problems of two paradoxes","volume":"43","author":"Feinstein","year":"1990","journal-title":"J Clin Epidemiol."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201908070-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:34:52Z","timestamp":1787751292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201908070-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,7]]},"references-count":11,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.01178","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,7]]}}}