Before treatment discuss the following information with the patient/parents/caretakers:
Nature of the injury
The chosen treatment and why a particular treatment is selected
General operative risks
Expected healing time
2. Procedure preparation
Consider if the planned closed reduction is likely to be the definitive fracture management. If there is a high likelihood of internal fixation it may be better to start the procedure in an operating room instead of an emergency department.
Personnel need to know and confirm:
Consent form, completed and signed
Site and side of fracture
Type of reduction planned
Operative site has been marked by the surgeon
Condition of soft tissues
Comorbidities, including allergies
Local nerve block or regional anesthesia is rarely used alone in children
Combination of nerve block and light general anesthesia
4. Patient position
Position the patient supine and optionally place the forearm in finger traps.
If necessary, apply a strap with weight over the middle third of the humerus to provide additional traction.
If tubular bandage is to be used, position it before applying finger traps and traction.
5. C-arm positioning
If available use a mini-C-arm in a horizontal position which can be rotated to take orthogonal views without moving the arm.