What type of splint is recommended for a nondisplaced epicondylar fracture of the elbow?

Posterior Splint for Nondisplaced Epicondylar Fracture of Left Elbow

A posterior splint (back-slab) is the recommended immobilization method for nondisplaced epicondylar fractures of the elbow, as it provides better pain relief compared to other immobilization techniques. 1

Evidence for Posterior Splinting

• Posterior splinting (back-slab) has been shown to provide superior pain relief within the first 2 weeks after injury compared to collar and cuff immobilization for nondisplaced pediatric supracondylar humeral fractures 1
• This recommendation is based on moderate quality evidence, including a randomized controlled trial with 50 patients and a prospective double-cohort study with 40 patients, both showing better pain outcomes with posterior splinting 1
• For nondisplaced fractures, rigid immobilization with a posterior splint provides adequate stabilization while allowing for appropriate healing 1, 2

Duration of Immobilization

• Immobilization should generally be limited to 2-3 weeks to prevent complications such as joint stiffness and muscle atrophy 2, 3
• Research shows that splinting for less than 2 weeks or 2-3 weeks yields better functional outcomes compared to immobilization for more than 3 weeks 3
• Excessive immobilization can lead to chronic pain, joint stiffness, and more severe complications like complex regional pain syndrome 2

Application Technique

• The posterior splint should be applied with the elbow in a position of approximately 90 degrees of flexion 2
• The splint should extend from the upper arm to the palm, maintaining the wrist in a neutral position 2
• Ensure the splint is well-padded to prevent pressure points, particularly over bony prominences 2

Monitoring and Follow-up

• Regular radiographic follow-up is essential to monitor fracture healing and detect any late displacement 1, 4
• Initial follow-up should occur within 1-2 weeks to assess fracture alignment 2
• Subsequent follow-up at 3-4 weeks to evaluate fracture healing and consider discontinuation of immobilization 2

Potential Complications and Pitfalls

• Nonunion of the epicondylar fragment may occur with nonsurgical treatment but does not necessarily adversely affect functional outcomes 4
• Inadequate immobilization can lead to displacement of the fracture, which may require surgical intervention 5
• Prolonged immobilization beyond what is necessary can lead to elbow stiffness, which is one of the most common complications 2, 3
• Elbow instability may be present even in nondisplaced or minimally displaced fractures due to unrecognized capsuloligamentous and muscular injuries 5

Special Considerations

• If there is evidence of intra-articular incarceration of the epicondylar fragment (occurs in 5-18% of cases), surgical intervention rather than splinting is indicated 6
• For fractures with significant displacement (>5mm), surgical fixation may be considered, though long-term studies show similar functional outcomes between nonsurgical treatment and surgical fixation 4
• Valgus stress testing under anesthesia may be warranted to assess elbow stability in cases where instability is suspected 5