What is the recommended treatment for a 5-year-old female (F) with an undisplaced, non-articular supracondylar fracture of the humerus?

Treatment for Undisplaced, Non-articular Supracondylar Fracture of the Humerus in a 5-Year-Old Female

For a 5-year-old female with an undisplaced, non-articular supracondylar fracture of the humerus, nonsurgical immobilization with a posterior splint is the recommended treatment due to better pain control and equivalent outcomes compared to other immobilization methods. 1

Initial Management

• Undisplaced supracondylar fractures (Gartland type I) should be treated with nonsurgical immobilization, as supported by moderate-strength evidence from the American Academy of Orthopaedic Surgeons (AAOS) guidelines 1
• A posterior splint (back-slab) is preferred over collar and cuff immobilization due to better pain relief within the first 2 weeks after injury 1
• This recommendation is based on two moderate-quality studies that demonstrated superior pain control with posterior splinting compared to collar and cuff methods 1

Immobilization Technique

• The posterior splint should allow inspection of the injured limb while providing adequate stabilization 1
• After splint application, orthogonal radiographs should be obtained to confirm fracture position 2
• A repeat neurovascular assessment of the limb is essential after immobilization to ensure no compromise has occurred 2

Follow-up Care

• The child should be provided with appropriate oral analgesia and safety information upon discharge 2
• Follow-up in a fracture clinic should be scheduled within 1 week of the injury 2
• Regular monitoring is necessary to ensure the fracture remains undisplaced during healing 1, 2

Potential Complications to Monitor

• Neurovascular injuries can occur even with undisplaced fractures and should be carefully assessed and documented 2
• Cubitus varus is the most frequent long-term complication of supracondylar fractures, with an incidence ranging from 3-57% in displaced fractures, though much less common in undisplaced fractures 3
• Monitoring for any signs of displacement during follow-up is crucial, as displacement would change the treatment approach 4

Duration of Immobilization and Activity Restrictions

• The AAOS guidelines note that there is insufficient evidence to recommend an optimal time for removal of immobilization 1
• Similarly, there is insufficient evidence to recommend an optimal time for allowing unrestricted activity after healing 1
• Clinical judgment must guide these decisions based on radiographic evidence of healing and the child's symptoms 1

Important Considerations

• A thorough neurovascular examination is essential at initial presentation and at each follow-up, assessing radial pulse, temperature, color, capillary refill time, and motor/sensory function of radial, median, and ulnar nerves 2
• If displacement occurs during treatment, the management approach would need to be reconsidered, potentially requiring closed reduction with pin fixation 1, 5
• Surgical intervention (closed reduction with pin fixation) is only indicated if the fracture becomes displaced during treatment 1, 5, 4

Rehabilitation

• The AAOS guidelines are unable to recommend for or against routine supervised physical or occupational therapy for patients with pediatric supracondylar fractures 1
• There is insufficient evidence regarding optimal timing of rehabilitation after these fractures 1
• Clinical judgment should guide the decision for rehabilitation based on the child's recovery of motion and function 1