What is the treatment for a nondisplaced supracondylar fracture of the humerus?

Treatment for Nondisplaced Supracondylar Fracture of the Humerus

Nonsurgical immobilization with a posterior splint is the recommended treatment for nondisplaced (Gartland type I) supracondylar fractures of the humerus. 1

Recommended Treatment Approach

Initial Management

• Posterior splint immobilization is superior to collar and cuff for pain control in the first 2 weeks after injury 1
• The splint should be an above-elbow posterior splint with the elbow flexed at approximately 90 degrees
• No reduction is required for truly nondisplaced fractures

Evidence for Splinting vs. Casting

• Two moderate quality studies demonstrated better pain relief with posterior splint/back-slab immobilization compared to collar and cuff for nondisplaced fractures 1
• Recent research shows both casting and splinting are effective immobilization methods with few complications 2
• Preliminary findings from a randomized controlled trial suggest functional and radiological outcomes with splinting are non-inferior to casting 3

Duration of Immobilization

• Typically 3-4 weeks of immobilization is required
• The AAOS guideline notes there is insufficient evidence to recommend an optimal time for removal of immobilization 1
• Caution should be exercised as early removal may increase risk of redisplacement or refracture

Long-term Outcomes and Follow-up

Expected Outcomes

• Long-term follow-up studies show excellent functional results in the majority of patients with nondisplaced fractures treated conservatively 4
• According to Flynn criteria, satisfactory results were observed in 80.4% of patients in one study 4
• Some patients may develop mild cubitus varus deformity and mild increase in elbow extension, but these rarely cause functional limitations 4

Rehabilitation

• The AAOS guideline is unable to recommend for or against routine supervised physical or occupational therapy 1
• No high-quality evidence exists regarding optimal timing for allowing unrestricted activity after healing 1
• Generally, gradual return to activities is recommended after immobilization is discontinued

Important Considerations and Pitfalls

Monitoring for Displacement

• Regular radiographic follow-up (typically at 1 week and 2-3 weeks) is essential to ensure the fracture remains nondisplaced
• If displacement occurs during treatment, conversion to surgical management with closed reduction and percutaneous pinning may be necessary

Distinguishing Fracture Types

• Ensure proper classification of the fracture as truly nondisplaced (Gartland type I)
• The severity of flexion-type supracondylar fractures may be difficult to appreciate on initial radiographs; maintain high index of suspicion 5
• Flexion-type fractures, even if minimally displaced, require special attention due to potential for ulnar nerve injury 5

Complications to Monitor

• Stiffness: Encourage early range of motion exercises after immobilization is discontinued
• Malunion: Monitor for development of cubitus varus deformity
• Neurovascular injury: Though rare in nondisplaced fractures, continued assessment is important

In summary, nondisplaced supracondylar humerus fractures have excellent outcomes with nonsurgical management using posterior splinting. The evidence strongly supports this approach over other immobilization techniques for pain control and functional outcomes.