Cast immobilization

The main goals of cast treatment of these fractures are:

• Uncomplicated healing
• 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.

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.

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

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.

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

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