Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-E/7L

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1 Goals top

The main goals for treatment (nonoperative or operative) of these ligament injuries are:

  • Restoration of elbow stability
  • Prevention of nonunion of the epicondyle
  • Prevention of secondary displacement

2 General considerations top


Minimally displaced 13-E/7L fractures can be managed with simple immobilization in a cast or splint.

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.

3 Posterior and anterior long arm splints top


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 top


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 plaster bandage are applied over the posterior splint.


The completed cast

v1.0 2016-12-01