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