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Immobilisation for Gartland I Supracondylar Humerus Fractures in Children: A Systematic Review
Sofia Bitsios1, Dominique Dennis1, Ramy Elemam2
1Orthopaedics, Norfolk and Norwich University Hospital, Norwich, GBR.
Insights
For Gartland I supracondylar humerus fractures in children, above-elbow splints or removable casts offer better pain control and faster recovery than collar-and-cuff. Immobilization for three weeks is typically sufficient.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Gartland I supracondylar humerus fractures are common, stable paediatric elbow injuries.
- Optimal immobilization balances pain control, alignment, and minimal disruption.
Purpose of the Study:
- Systematically review immobilization and casting options for Gartland I fractures.
- Summarize safety, pain, functional recovery, satisfaction, and practical aspects.
Main Methods:
- Systematic review of randomized and observational studies.
- Analysis of literature on immobilization techniques and materials.
Main Results:
- Gartland I fractures rarely displace regardless of immobilization.
- Above-elbow splints/backslabs reduce pain and improve function compared to collar-and-cuff.
- Removable casts/long-arm splints are comparable to rigid casts, improving patient experience.
Conclusions:
- A three-week above-elbow posterior splint or removable cast is typically sufficient for Gartland I fractures.
- Collar-and-cuff alone is less effective for early symptom control.
- Innovative materials enhance comfort; application technique and education are crucial.
Abstract:
Gartland I supracondylar humerus fractures are non-displaced, stable injuries of the paediatric elbow. Optimal immobilisation aims to control pain and protect alignment while minimising disruption to children and families. This systematic review aims to review the currently available literature on immobilisation and casting options for Gartland I supracondylar fractures, summarising safety (displacement/complications), pain and functional recovery, satisfaction, and practical considerations. Across randomised and observational studies, type I supracondylar fractures rarely displace irrespective of immobilisation. Compared with collar-and-cuff alone, above-elbow posterior splints or backslabs reduce pain, analgesia use, and sleep disturbance, and accelerate return to activity. Removable (soft) casts and long-arm splints are non-inferior to rigid long-arm casts for radiographic and functional outcomes, while often improving convenience and parent and patient experience. Newer materials (waterproof or hybrid-mesh liners, biobased polyester, and 3D printed orthoses) further enhance comfort without compromising stability. In conclusion, for Gartland I supracondylar fractures, a well-applied above-elbow posterior splint or removable long-arm cast for around three weeks is typically sufficient. Collar-and-cuff alone is generally inferior for early symptom control. Innovative techniques and casting materials can be offered where available but may require further research to assess their outcomes. Application technique and education remain critical.
