Letter to the Editor regarding: “Preoperative Prediction of Gartland IV Supracondylar Fractures of Humerus: Is it Possible?” Barik S, Singh G, Maji S, Azam Q, Singh V. Rev Bras Ortop 2021;56(2):230-234.

Barik et al.1 reported a 7 to 10% incidence of type-IV fractures for all operated supracondylar fractures, referencing Leitch et al.,2 but the latter documented an incidence of only 3% (9 of 297 fractures). Mitchell et al.4 identified an incidence of 1.3% (3,040 fractures) with a type IV/III ratio of 39/156, which is much lower than the IV/III ratio of 17/16 reported by Barik et al.1 The latter authors reported that one important limitation of their study is that a few surgeries were performed by pediatric orthopedic fellows, which might have influenced the fracture classification. A possible misclassification of type IIIs as type IVs could have contributed to the large discrepancy between the authors' high type-IV rate of 51.5% and the 20% reported by Mitchell et al.4 in addition to the possibility of type IVs having been created during multiple reduction attempts by less experienced pediatric orthopedic fellows.

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