Gartland type I supracondylar humerus fractures in children: is splint immobilization enough?

The primary objective of this study was to determine if Gartland type I supracondylar humerus (SCH) fractures undergo significant displacement resulting in a change in management when treated with a long-arm splint. Secondary objectives included measured changes at follow-up in displacement and/or angulation.

This was a retrospective review of children who presented with elbow injuries to a children's hospital. Patients were included if they were diagnosed with a Gartland type I SCH fracture, managed with a long-arm splint, and had at least 1 follow-up visit 2 to 3 weeks from the emergency department visit. The primary outcome was the proportion of cases that required the placement of a circumferential cast and/or an operative intervention. Secondary outcomes included the proportion of cases with significant changes in displacement on any view, Baumann or the lateral humerocapitellar angle, and/or category of position of anterior humeral line relative to capitellum.

Of 804 elbow injuries that presented from 2003 to 2008, 53 patients met the inclusion criteria. The median age of the patients was 4.1 years (interquartile range, 3.4-6.1 years) years. Of the 53, there were no cases that required a change in management. One case had a change in the humerocapitellar angle, and another had a change of 1 category in position of the capitellum relative to the anterior humeral line. There were no other cases of significant changes in displacement or angulation.

These data support that Gartland type I SCH fractures can be treated effectively with long-arm posterior splinting for the duration of therapy.