Reply to Letter to the Editor Regarding the Article: “Preoperative Prediction of Gartland IV Supracondylar Fractures of the Humerus: Is it Possible?”

To the Editor,

It was a delight to go through a critical analysis of the article by Barik et al.¹ The findings in the study are not in tune with the previously published studies on multidirectional unstable supracondylar humerus fracture.²,³

The fractures are known to be created iatrogenically during intraoperative reduction of type III Gartland supracondylar humerus fractures.² It has been highlighted by Barik et al.¹ that the competency of the operating surgeon can play an important role in the creation of these type IV fractures. The discrepancy noted in the rate of neurovascular status of type IV fractures may be attributed to the sample size, compared with that of other studies. We agree that the management protocol as envisaged by Flynn et al. should be a guiding light for less-experienced surgeons, which would prevent iatrogenic conversion of type III to type IV fractures.⁴

To conclude, as advised, appropriate referral systems for these fractures should be instituted so that they are managed at specialized centers by well-trained surgeons who manage these fractures frequently.

References

• ¹
  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;56(02): 230-234
• ²
  Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture. J Bone Joint Surg Am 2006;88(05):980-985
• ³
  Mitchell SL, Sullivan BT, Ho CA, Abzug JM, Raad M, Sponseller PD. Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion- Type Fractures. J Bone Joint Surg Am 2019;101(15):1351-1356
• ⁴
  Flynn JM, Skaggs DL, Waters PM. Rockwood and Wilkins’: Fractures in Children. 8th. Philadelphia, PAWolters Kluwer2015. [cited 2021 Oct 5]; Available from: https://orthopaedics.lwwhealthlibrary.com/book.aspx?bookid=918
  » https://orthopaedics.lwwhealthlibrary.com/book.aspx?bookid=918

Publication Dates

• Publication in this collection
  21 Nov 2022
• Date of issue
  Sep-Oct 2022

History

• Received
  12 Oct 2021
• Accepted
  22 Nov 2021