Orthopedic or Surgical Treatment in Gartland Type II Supracondylar Humerus Fractures: A Systematic Review

Abstract

Background

There is a broad consensus among orthopedic surgeons in the treatment of Gartland type I supracondylar humerus fractures (conservative) and Gartland type III (surgical) fractures, but there is controversy regarding the treatment of choice for Gartland type II fractures. The aim was to analyze the existing current evidence on the choice of surgical or conservative treatment of Gartland type II supracondylar humerus fractures.

Methods

A systematic review was carried out following the PRISMA guidelines. The search was conducted on May 24, 2023, in PubMed and Cochrane Central, introducing the terms (“humerus” AND “supracondylar”) AND (“Gartland II” OR “Gartland 2”). The selected studies were evaluated with the JBI checklist for quasi-experimental studies.

Results

5 retrospective comparative studies were included (evidence level III). Radiological and functional results were good with both treatments. Only one study obtained a better result with surgical treatment (with n = 4 in the conservative group); the other four studies did not find significant differences between the two types of treatment. There are risks of bias in all studies.

Conclusions

Both types of treatment (conservative and surgical) are valid for type II Gartland supracondylar humerus fractures, and provide good results, both functional and radiological. There is not enough scientific evidence to be able to affirm that one of the two treatments (surgical or conservative) is superior to the other for the treatment of these fractures. Findings on the initial radiograph, such as rotational deformity, coronal malalignment, or a severely angulated distal humeral fragment, can assist in the decision-making process.