Executive Editor: Fergal Monsell General Editor: Chris Colton

Authors: Andrew Howard, Theddy Slongo

Pediatric distal humerus 13-M/7M

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Glossary

1 Introduction top

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Undisplaced fractures are immobilized for protection and comfort.

The recommended technique is to use a plaster or fiberglass backslab with 90° of elbow flexion.

A sling may be used for comfort according to the child's, or parental, preference.

2 Splint application top

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Application of cast padding

Cast padding is wrapped around the upper arm, elbow, forearm and hand, as far as the transverse flexor crease of the palm (the MP joints are left free). According to surgeon's preference a tubular bandage may be applied to the arm beneath the padding.

The elbow is held in 90° flexion and the forearm in neutral rotation.

It is important to make sure that the epicondyles of the humerus and the antecubital area are padded well.


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Application of splint

A splint of fiberglass, or plaster, is applied on the posterior aspect of the arm and forearm. It should be wide enough to cover more than half the circumference of the arm and forearm.


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The splint is secured with a noncompressive bandage.

It is very important to ensure that this is not tight, so as to accommodate subsequent swelling.


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Sling

The injured arm and cast are supported with a sling.


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Analgesia

Nonnarcotic analgesia may be required.

Caregivers should be taught to monitor for excessive pain or other signs of potentially dangerous swelling.

Pearl: The ability to passively, or actively, fully extend the fingers without discomfort indicates normal perfusion and absence of neurological compromise, or muscle compartment compression.

v1.0 2016-12-01