Sling/Arm Pouch for Nondisplaced Ulna Fracture Near the Elbow
For a nondisplaced ulna fracture near the elbow, use a posterior splint for immobilization rather than a simple sling or arm pouch, as posterior splinting provides superior pain relief and adequate fracture stabilization.
Immobilization Strategy
Posterior splinting is the recommended approach for nondisplaced fractures near the elbow based on American Academy of Orthopaedic Surgeons guidelines 1. This provides:
- Superior pain relief within the first 2 weeks after injury compared to collar and cuff immobilization (which is essentially a sling), demonstrated in randomized controlled trials 1
- Adequate rigid stabilization while allowing appropriate healing for nondisplaced fractures 1
Why Not Just a Sling?
A simple sling or arm pouch alone is insufficient because:
- Nondisplaced fractures require rigid immobilization to maintain alignment and prevent displacement 1
- Studies comparing posterior splints to collar-and-cuff (sling-type) immobilization consistently show better pain control with rigid splinting 1
- The posterior splint provides three-point fixation that a sling cannot achieve 1
Specific Management Algorithm
For nondisplaced ulna fractures near the elbow:
- Apply a posterior splint immediately with the elbow at 90 degrees of flexion 1
- The splint should extend from the upper arm to the proximal forearm, immobilizing the elbow joint 1
- A sling may be used as an adjunct to support the weight of the arm and provide comfort, but it is not the primary immobilization device 2
- Obtain radiographic follow-up to monitor for late displacement, as even initially nondisplaced fractures can shift 1
Duration and Follow-up
- Regular radiographic monitoring is essential to detect any late displacement 1
- Follow-up imaging should occur at approximately 3 weeks 3
- The immobilization period depends on fracture healing but typically ranges from 3-6 weeks for stable fractures 2
Common Pitfall to Avoid
Do not rely on a sling alone for immobilization—this provides inadequate stabilization and inferior pain control compared to posterior splinting 1. The sling should only serve as a comfort measure to support the splinted arm, not as the primary treatment modality.