Is Non-Operative Management With Closed Reduction and Casting a Safe Option for Gartland Type II Supracondylar Fractures? A Review of the Literature.

Gartland type II supracondylar humerus fractures represent a spectrum of injuries in children where treatment remains controversial. Although current guidelines favour operative fixation, emerging evidence suggests that non-operative treatment may be appropriate for selected cases. This review summarises current literature on the safety and efficacy of non-operative management for Gartland type II fractures and identifies radiographic and clinical predictors of treatment success or failure. Retrospective and prospective studies comparing operative and non-operative approaches were analysed, with particular attention to predictors of reduction loss and the influence of the IIA/IIB Wilkins-modified subclassification. Success rates for non-operative treatment ranged from 70% to 90% in carefully selected cases, with loss of reduction occurring in 10%-25%, especially in fractures with extension deformity, sagittal obliquity or metaphyseal fragmentation. Subclassification improved prognostic accuracy: type IIA fractures were generally stable, while type IIB fractures had higher failure rates. However, these appeared best combined with other valuable radiographic predictors of stability, including the hourglass angle, humerocapitellar angle and anterior humeral line index. When alignment was maintained, functional outcomes were comparable between operative and non-operative groups. In conclusion, non-operative management with closed reduction and casting is safe for select Gartland type II fractures with favourable radiographic features. However, close follow-up with early repeat imaging is essential, and standardised selection criteria remain lacking. Future multicentre prospective studies are needed to validate radiographic thresholds and refine treatment guidelines.