What type of splint is recommended for a distal humerus fracture?

Posterior Splint for Distal Humerus Fractures

For distal humerus fractures, a posterior splint (also called back-slab) is recommended as the initial immobilization method, as it provides better pain relief in the first two weeks after injury. 1

Initial Management Considerations

The choice of immobilization depends on several factors:

• Fracture displacement:

  • Nondisplaced fractures: Can be managed with splinting
  • Displaced fractures (Gartland type II and III): Typically require closed reduction with pin fixation 1

• Patient age:

  • Pediatric patients: Posterior splinting is particularly effective
  • Adult patients: May require more definitive fixation depending on fracture pattern

Splinting Technique

For proper immobilization of a distal humerus fracture:

1. Position: The elbow should be in approximately 90 degrees of flexion
2. Coverage: The splint should extend from the upper arm to the hand
3. Material: Plaster or fiberglass posterior splint
4. Padding: Adequate padding is essential to prevent pressure sores
5. Swelling management: Avoid circumferential casting initially if significant swelling is present or anticipated

Evidence Supporting Posterior Splinting

The American Academy of Orthopaedic Surgeons (AAOS) guideline on pediatric supracondylar humerus fractures found that posterior splinting provides superior pain relief within the first two weeks compared to other immobilization methods 1. This is particularly important in the acute phase of injury management.

Important Considerations and Pitfalls

• Avoid hyperflexion: Casting the arm in hyperflexion may cause limb-threatening ischemia 1
• Monitor neurovascular status: Regular checks are essential, especially in the first 24-48 hours
• Watch for compartment syndrome: Maintain high vigilance for signs of increasing pain, paresthesias, or pallor
• Proper padding: Insufficient padding can lead to pressure sores, particularly over bony prominences
• Duration: Immobilization is typically needed for 3-4 weeks, though this varies by fracture pattern and healing progress

When Splinting Is Not Enough

Certain situations require more than just splinting:

• Displaced fractures: The AAOS guideline suggests closed reduction with pin fixation for displaced (Gartland types II and III) pediatric supracondylar fractures 1
• Comminuted fractures: May require open reduction and internal fixation, particularly in adults 2
• Intra-articular fractures: Often require surgical intervention to restore joint congruity 2
• Elderly patients: May benefit from total elbow arthroplasty for comminuted intra-articular fractures 2

Follow-up Care

• Early passive range of motion exercises should begin as soon as acute pain resolves
• Regular radiographic follow-up is necessary to ensure maintenance of reduction
• Progressive rehabilitation should be initiated after the immobilization period

Remember that while posterior splinting is effective for initial management, the definitive treatment plan should be based on fracture pattern, displacement, and patient factors.