Collar and cuff immobilization

This technique was traditionally advocated because it avoided rigid plaster splinting and did not involve circumferential wrapping of the limb at the elbow.

Recent evidence suggests that children experience more discomfort during the first week when this technique is used.

The forearm is supported with approximately 60° of elbow flexion and a padded neck collar and a distal forearm cuff is applied. The collar and cuff can be held together with a safety pin.

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

Analgesia, including ibuprofen and paracetamol, should be administered regularly.

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

The child should be examined frequently, 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.

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

Control x-rays may be taken at one week following injury to assess fracture position. Further x-rays may be necessary at three weeks to assess fracture healing.

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, usually within two months of splint removal. 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 of judgment for the treating surgeon.