Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/3.1

Cast immobilization

1. Goals

The main goals of cast treatment of these fractures are:

  • Uncomplicated healing
  • No secondary displacement

2. Introduction

Keep in mind that, for these fractures, the plaster cast cannot hold the fragment in place. It is only an immobilization of the joint.

In children, it is recommended to immobilize the elbow joint by a splintage configuration that effectively immobilizes the elbow joint. A single posterior splint is not usually adequate.

See also the additional material on preoperative preparation .

3. Posterior and anterior long arm splints

Two splints are prepared according to the correct posterior and anterior lengths. The posterior splint extends from the metacarpal heads to the proximal third of the humerus. The anterior splint extends from the palmar flexor crease to the proximal third of the humerus.

The two splints are held in place with an elastic spiral bandage. The tubular bandage is then folded back over the splints above and below.

4. Circular plaster cast

Cast padding

Circular cast padding is applied from the metacarpal heads to the axilla.

Application of plaster cast and splint

Circular plaster cast is applied in the same way, starting from the hand and going up to the proximal humerus.

After 2-3 layers of circular plaster cast, it is recommended to apply an additional posterior splint to increase stability.

2-3 more layers of elastic plaster bandage are applied over the posterior splint.

The complete cast.



Decision support

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v1.0 2016-12-01