Cutting edge Orthopedics

4 • CUTTING EDGE - ORTHOPEDICS 39 acture with ized poste- Fig. 4.4 Lateral view of a Gartland Type IIB fracture demonstrating an intact posterior hinge with rotation deformity (Courtesy of Joshua M. Abzug, MD) Fig. 4.3 Lateral view of a Gartland Type IIA fracture with extension of the distal fragment relative to the ante- rior humeral line ( white line ). In an uninjured elbow in children aged 4 or older, the anterior humeral line should intersect the middle third of the capitellum (Courtesy of Joshua M. Abzug, MD) Fig. 4.4 Lateral view of a Gartland Type IIB fracture demonstrating an intact posterior hinge with rotation deformity (Courtesy of Joshua M. Abzug, MD) Fig. 4.5 Lateral view of a Gartland Type III fracture with complete displacement of the distal fragment (Courtesy of Joshua M. Abzug, MD) Fig. 3: Lateral view of a Gartland Type IIA fracture with extension of the distal fragment relative to the anterior humeral line ( white line ). In an uninjured elbow in children aged 4 or older, the anterior humeral line should intersect the middle third of the capitellum (Courtesy of Joshua M. Abzug, MD). Fig. 4: Lateral view of a Gartland Type IIB fracture demonstrating an intact posterior hinge with rotation deformity (Courtesy of Joshua M. Abz g, MD). supracondylar humerus fracture with multidirectional instability, i.e., unstable in both extension and flexion with manipulation, which typically needs to be determined in the operating room [17]. Additionally, fractures that were originally unstable in extension can be inadvertently con- verted to a Type IV fracture during attempts at closed reduction [17].