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Three Part Question

In [ patients with supracondylar humeral fractures requiring MUA ] is [ collar and cuff post op. as effective as other methods of splinting ] at [ reducing long term complications ].

Clinical Scenario

You have just performed a manipulation under anaesthesia for a displaced supracondylar fracture in a child. Check X-rays reveal a satisfactory reduction. You wonder whether a simple collar and cuff is as effective as other means of holding reduction.

Search Strategy

MEDLINE 1966 to 11/2002, using OVID
[exp humeral fractures] AND [exp calcium sulfate/ OR plaster of paris cast.mp. OR collar and cuff.mp.]

Search Outcome

26 papers were found of which 4 were relevant but only 1 addressed the specific question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Kennedy,-J-G; El-Abed,-K; Soffe,-K; Kearns,-S; Mulcahy,-D 2000 April U.K.	84 children were studied prospectively. 40 patients were Gartland type II. 44 patients were classed as Gartland III injuries. Of the Type II injuries 33 were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Of Type III injuries 14 had closed reduction and collar and cuff while 25 had closed reduction and percutaneous pinning. 5 had open reduction and pinning.	PRCT	foll. MUA and pin fixation-2 cases of cubitus varus, 1 case of cubitus valgus, 1 case of extension lag and 1 case of ulnar nerve neuropraxia. Following manipulation and collar and cuff only 1 case was complicated by cuitus varus.	There was no statistical difference in either treatment modality in terms of predicting a better outcome (p0.05)	Small sample size. Only children studied.

Comment(s)

Proper management of supracondylar fractures is of paramount importance, malunion causes significant deformity and disability. Optimal management methods have been explored by some authors but further studies are needed. This paper suggests that pin fixation has no advantages over simple immobilisation in only certain types of Gartland II and III supracondylar fractures.

Clinical Bottom Line

If a supracondylar fracture is judged to be unstable then pin fixation is beneficial. However if the fracture is stable, then collar and cuff seems to be a relatively safe alternative.

References

1. Kennedy,-J-G; El-Abed,-K; Soffe,-K; Kearns,-S. Evaluation of the role of pin fixation vs collar and cuff immobilisation in supracondylar fractures in children. Injury- 2000 April; 31(3):163-7.