Authors of section

Authors

Andrew Howard, Theddy Slongo

Executive Editor

Fergal Monsell

General Editor

Chris Colton

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Splint immobilization

1. General considerations

Note: Physeal separation of the distal humerus with a metaphyseal fragment may be associated with nonaccidental injury. There is a risk of compartment syndrome associated with management in hyperflexion. Treatment of these injuries can also be technically demanding because of the small size of the child.

Rather than undertaking treatment that could be risky, the surgeon should take into account the considerable potential for modelling of a malunion, particularly in the infant.

Children without evidence of fracture callus are often brought to the operating room for examination under anesthesia in order to establish a diagnosis.

Fracture stability and position must be checked, arthrography can be very useful as described in the diagnosis section. If the fracture is found to be stable and in an acceptable position clinically and radiographically, then it can be managed with protective immobilization.

See also the additional material on preoperative preparation.

splint immobilization

2. Immobilization

The arm is immobilized in a splint with the elbow in 90° flexion.

splint immobilization

Bandaging the arm to the body is comfortable in young children.

splint immobilization

3. Postoperative care

Supracondylar humeral fractures heal rapidly and often within 3-5 weeks.

Immobilization with the elbow in 90° flexion is recommended for fractures treated without pinning.

Immobilization with the elbow in 45°-90° flexion is recommended for fractures treated with intraosseous K-wires.

Analgesia, including ibuprofen and paracetamol, should be administered regularly, with additional oral narcotic medication for breakthrough pain.

splint immobilization

Compartment syndrome

Compartment syndrome is a possible early postoperative complication that may be difficult to diagnose in younger children.

The child should be examined regularly, to ensure finger range of motion is comfortable and adequate.

Neurological and vascular examination should also be performed.

Increasing pain, decreasing range of finger motion, or deteriorating neurovascular signs should prompt consideration of compartment syndrome.

See also the additional material on postoperative infections.

splint immobilization

Discharge care

When the child is discharged from the hospital, the parent/caregiver should be taught how to assess the limb.

They should also be advised to return if there is increased pain or decreased range of finger motion.

It is important to provide parents with the following additional information:

  • The warning signs of compartment syndrome, circulatory problems and neurological deterioration
  • Hospital telephone number
  • Information brochure

For the first few days, the elbow and forearm can be elevated on a pillow, until swelling decreases and comfort returns.

When the limb is comfortable, the child may optionally use a sling to support any splint if desired. Many children are more comfortable without a sling.

splint immobilization

Follow-up x-rays

Control x-rays may be taken at one week following injury to assess fracture position and then at three weeks, out of any splintage, to assess fracture healing.

Removal of cast or splint

Fractures treated by closed reduction with splints, or casts, and fractures treated with closed reduction and percutaneous pinning should have the splintage removed 3 weeks after the injury date.

K-wire removal

Protruding K-wires can be removed in the clinic, without anesthesia.

A simple sling can be provided for comfort.

Recovery of motion

As symptoms recover, the child should be encouraged to remove the sling and begin active movements of the elbow.

The majority of elbow motion is recovered rapidly within the two months after the splint is removed. The older child may take a little longer.

Once the child is comfortable, with a nearly complete range of motion, he/she may resume noncontact sports incrementally. Resumption of unrestricted physical activity is a matter for judgment by the treating surgeon.