From the Research
For a mid-shaft humerus fracture in a 5-year-old female, I recommend a sugar-tong splint or a coaptation (U-shaped) splint with the elbow flexed at 90 degrees, as this approach prioritizes the prevention of morbidity, mortality, and optimization of quality of life by allowing for proper healing and minimizing complications 1.
Key Considerations
- The splint should extend from the axilla, around the elbow, and up to the shoulder to immobilize both the elbow and shoulder joints, thereby preventing rotation and angulation that could hinder the healing process.
- Apply padding, particularly at bony prominences, before applying the plaster or fiberglass material to ensure comfort and prevent skin irritation.
- The arm should be supported with a sling to reduce movement and stress on the fracture site.
- This splint should be maintained until orthopedic follow-up, typically within 5-7 days, to assess the fracture's alignment and the child's overall condition.
Management and Monitoring
- Children's bones heal faster than adults, but complete healing usually takes 4-6 weeks, during which time regular follow-ups are crucial to monitor the healing progress and address any potential issues early.
- Most pediatric mid-shaft humerus fractures can be treated non-operatively due to children's remarkable remodeling capacity, which reduces the need for surgical intervention in many cases.
- Monitor for signs of neurovascular compromise such as increasing pain, numbness, color changes, or swelling, and address these concerns promptly to prevent long-term damage.
- The child should avoid physical activities that could cause re-injury until cleared by the orthopedic surgeon to ensure the fracture heals properly and to minimize the risk of complications.
- Pain can be managed with weight-appropriate doses of acetaminophen or ibuprofen, balancing the need for pain relief with the potential risks associated with medication use in children 1.