Recommended Initial Immobilization for Distal Humeral Supracondylar Fracture
A posterior splint is the recommended initial immobilization method for distal humeral supracondylar fractures as it provides better pain relief in the first 2 weeks compared to collar and cuff immobilization. 1
Assessment and Classification
The management approach depends on:
- Patient age (pediatric vs. adult)
- Fracture displacement (undisplaced vs. displaced)
- Neurovascular status
For pediatric patients, the Gartland classification is commonly used:
- Type I: Undisplaced
- Type II: Displaced with intact posterior cortex
- Type III: Completely displaced
Initial Immobilization Recommendations
For Undisplaced Fractures (Gartland Type I):
- Above-elbow posterior fiberglass slab with broad arm sling is superior to collar and cuff alone 2
- Results in shorter duration of pain (median 4.0 days vs. 6.0 days)
- Faster return to normal activity (median 2.0 days vs. 7.0 days)
- Higher parental satisfaction (96% vs. 83%)
For Displaced Fractures (Gartland Type II and III):
- Initial immobilization with posterior splint before definitive treatment
- Most displaced fractures will require surgical intervention with closed reduction and percutaneous pinning 3
Positioning Considerations
- For pediatric patients: The American Academy of Orthopaedic Surgeons does not provide definitive recommendations on optimal positioning 4
- Traditional approach: Immobilization with elbow in flexion
- Alternative approach: Some evidence supports immobilization with elbow in extension to neutralize both extensor and flexor muscles, potentially preventing cubitus varus deformity 5
Duration of Immobilization
- Initial immobilization should be maintained until definitive treatment
- For undisplaced fractures treated non-operatively, immobilization typically lasts 3-4 weeks
- For surgically treated fractures, pins are typically removed after 4 weeks according to European Paediatric Orthopaedic Society survey 3
Adult vs. Pediatric Considerations
Adult supracondylar fractures: Often require different management approaches
Pediatric supracondylar fractures: Closed reduction with percutaneous pinning is the preferred approach for displaced fractures 1
Complications to Monitor
- Neurovascular compromise (requires immediate intervention)
- Cubitus varus deformity (most common long-term complication)
- Elbow stiffness (can be minimized with appropriate rehabilitation)
Follow-up Protocol
- Regular radiographic evaluation at 1,3, and 6 weeks
- Clinical assessment of pain and range of motion at each follow-up
- Early controlled mobilization once fracture stability is ensured
The evidence strongly supports the use of a posterior splint for initial immobilization of supracondylar fractures, particularly in the pediatric population, as it provides superior pain control and functional outcomes compared to collar and cuff alone.