The main goals of cast treatment of these fractures are:
No secondary displacement
Keep in mind that, for these fractures, the plaster cast cannot hold the fragment in place. It is only an immobilization of the joint.
In children, it is recommended to immobilize the elbow joint by a splintage configuration that effectively immobilizes the elbow joint. A single posterior splint is not usually adequate.
3. Posterior and anterior long arm splints
Two splints are prepared according to the correct posterior and anterior lengths. The posterior splint extends from the metacarpal heads to the proximal third of the humerus. The anterior splint extends from the palmar flexor crease to the proximal third of the humerus.
The two splints are held in place with an elastic spiral bandage. The tubular bandage is then folded back over the splints above and below.
4. Circular plaster cast
Circular cast padding is applied from the metacarpal heads to the axilla.
Application of plaster cast and splint
Circular plaster cast is applied in the same way, starting from the hand and going up to the proximal humerus.
After 2-3 layers of circular plaster cast, it is recommended to apply an additional posterior splint to increase stability.
2-3 more layers of elastic plaster bandage are applied over the posterior splint.
The complete cast.
If the child remains for some hours/days in bed, the hand should be held in an elevated vertical position in a roller towel to reduce swelling and pain.