Authors of section

Authors

Andrew Howard, Theddy Slongo

Executive Editor

Fergal Monsell

General Editor

Chris Colton

Open all credits

Cast immobilization

1. Goals

The main goals of cast treatment of these fractures are:

  • Uncomplicated healing
  • No secondary displacement

2. Introduction

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.

See also the additional material on preoperative preparation.

cast immobilization

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.

cast immobilization

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.

13 e 31

4. Circular plaster cast

Cast padding

Circular cast padding is applied from the metacarpal heads to the axilla.

cast immobilization

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.

cast immobilization

After 2-3 layers of circular plaster cast, it is recommended to apply an additional posterior splint to increase stability.

cast immobilization

2-3 more layers of elastic plaster bandage are applied over the posterior splint.

cast immobilization

The complete cast.

13 e 31

5. Postoperative care

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.

See also the additional material on postoperative infection and healing time.

cast immobilization

After discharge from hospital, the casted arm should be held in a sling for immobilization.

cast immobilization

Note: In any case of elbow immobilization by plaster cast, careful observation of the neurovascular situation is essential both in the hospital and at home.

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

Note: Bearing in mind that this is a rare injury and that interpretation of x-rays is difficult, give strong consideration to early referral of the child to a specialist unit.