Proximal forearm fractures require immobilization with a splint to control forearm rotation and therefore decrease the risk of displacement.
Simple application of a splint is performed without sedation in older children and in compliant younger children.
The environment should be one in which the child and the parents/carers are comfortable.
Important considerations include:
When a procedure including manipulation is required, general anesthesia or conscious sedation is usually necessary.
Pearl: Finger traps
Holding the arm using finger traps as illustrated allows easy manipulation, reduction, imaging, and mobilization for a surgeon working without an assistant.
To avoid damage to the skin of the fingers ensure that the pressure is evenly distributed, and that prolonged or excessive force is avoided.
Application of cast padding
Hold the elbow in 90° flexion and the forearm in neutral rotation.
Wrap cast padding around the upper arm, elbow, forearm and hand, as far as the transverse flexor crease of the palm (the MP joints are left free). According to surgeon’s preference a tubular bandage may be applied to the arm beneath the padding.
Make sure that the epicondyles of the humerus and the antecubital area are well padded.
Application of splint
Apply a splint of fiberglass, or plaster, on the posterior aspect of the arm and forearm. It should be wide enough to cover more than half the circumference of the arm and forearm.
Secure the splint with a noncompressive bandage.
Ensure that this is not tight, to accommodate subsequent swelling.
The injured arm and splint are supported with a sling.