Post-Operative Splinting Versus Casting of Pediatric Supracondylar Humerus Fractures

Abstract

Background Supracondylar humerus fractures (SCH) are common upper extremity fractures in children and are usually treated by closed reduction and percutaneous pinning. Post-operative management may cause complications, but the difference between cast and splint has not been closely investigated. Purpose Our objective was to compare casting and splinting of SCH fractures with respect to post-operative complications. Patients and methods We reviewed 1,146 pediatric SCH fractures that were reduced, percutaneously pinned, and immobilized by cast or splint. Open fractures, openly reduced fractures, and pre-operative neurological injuries were excluded. Over the course of immobilization, we noted if the initial cast or splint was maintained and if the patient returned due to complications. Results Post-operative casting was performed on 1,091 (95.2%) fractures and 55 (4.8%) were splinted. Age was a significant factor, increasing the likelihood of splinting by 12% with each year of age (p = 0.023). A total of 28 patients (2.4%) returned for unscheduled visits due to immobilization complaints, infection, and pain, but the rate difference between cast and splint was negligible. Reoperation was required for five patients (0.4%), and more likely for splinted fractures (p = 0.021). After controlling for age, splinting was still associated with reoperation (OR: 15.1, p = 0.004). Conclusions Although complications inevitably exist, both casting and splinting are effective immobilization methods. Both resulted in few complications such as post-operative discomfort, pain, infection, loss of reduction, or damage. It was difficult to evaluate significance with few splinted cases, but considering no major differences between splinted and casted fractures, clinicians should consider splinting to reduce the cost associated with casting.

Postoperative Immobilization Period for Pediatric Supracondylar Fractures: The Shorter the Better?

“…A recent Cochrane review into supracondylar treatments, unfortunately, did not investigate this, likely a reflection of the paucity of evidence in this area, and a study by Lee and colleagues in 2021 comparing complication rates of pinned supracondylar fractures immobilized postoperatively in splint versus cast failed to comment on the length of time immobilized between the two groups, again likely highlighting the large variation in these data. 12,13 In a recent paper by Pavone et al, 14 outlining results from a survey of the members of the European Paediatric Orthopaedic Society, almost the entire sample of 184 members declared that pins should be removed between 3 and 4 weeks postoperatively, but there was no indication regarding the period of immobilization, or if there needs to be any further immobilization after pins are removed. Sheikdon et al 15 in 2022 suggested that prolonged immobilization of these fractures for 6 weeks postoperatively rather than 4 was significantly associated with unsatisfactory functional management outcomes of a range of motion and carrying angle at 6 months.…”

“…The duration of immobilization following reduction and K-wire fixation of displaced supracondylar fractures is variable among different surgical centers worldwide, and due to the lack of trials investigating this, there remains no evidence-based recommendation. A recent Cochrane review into supracondylar treatments, unfortunately, did not investigate this, likely a reflection of the paucity of evidence in this area, and a study by Lee and colleagues in 2021 comparing complication rates of pinned supracondylar fractures immobilized postoperatively in splint versus cast failed to comment on the length of time immobilized between the two groups, again likely highlighting the large variation in these data 12,13 . In a recent paper by Pavone et al, 14 outlining results from a survey of the members of the European Paediatric Orthopaedic Society, almost the entire sample of 184 members declared that pins should be removed between 3 and 4 weeks postoperatively, but there was no indication regarding the period of immobilization, or if there needs to be any further immobilization after pins are removed.…”

Value-Driven Pediatric Supracondylar Humerus Fracture Care: Implementing Evidence-Based Practices

“…Multiple studies have shown no difference in unscheduled returns or secondary displacement with splinting versus casting. 37,38 The author has had good success with ∼10 layers of plaster for a posterior splint supplemented with a ∼5-layered lateral slab to cover pins, with an ACE wrap applied directly onto the plaster while drying to make it harder to remove.…”