Immobilisation in a collar and cuff with high elbow flexion is a safe and effective treatment option to reduce and immobilise Gartland type II supracondylar fractures

TL;DR

Using a collar and cuff with high elbow flexion safely treats Gartland type II elbow fractures in children without needing surgery.

Contribution

Demonstrates collar and cuff immobilization with >90° elbow flexion is effective for Gartland type II fractures.

Findings

34 out of 42 patients were successfully treated non-surgically with no complications.

High elbow flexion significantly improved the lateral humeral–capitellar angle.

No patients required corrective osteotomy or further surgical intervention.

Abstract

This study aimed to report the proportion of children requiring subsequent surgical intervention, rate of complications and radiologic outcomes following collar and cuff immobilisation with high elbow flexion (>90°) for Gartland type II supracondylar fractures.

A retrospective case series of consecutive patients aged <18 years with Gartland type II fractures treated at a level 1 trauma centre from December 2020 to April 2023 was conducted. The need for surgical intervention and complications were recorded from electronic clinical notes. The initial, post-immobilisation and final Baumann's angle and lateral humeral–capitellar angle (LHCA) were measured and compared.

In total, 42 patients were included in this study. Thirty-four were treated definitively in a collar and cuff with a mean elbow flexion of 109.4°. Two patients underwent closed reduction and Kirschner wire fixation. No patient required subsequent corrective osteotomy. There were no cases of recorded complications. Immobilisation in a collar and cuff with >90° elbow flexion was associated with a significant improvement in the mean LHCA (initial 80.9° vs final 65.6°, p < 0.001). There was no significant change in the LHCA post immobilisation in a collar and cuff until final radiographic follow-up (post immobilisation 68.3° vs final 65.6°, p=0.274).

Immobilisation in a collar and cuff with high elbow flexion is a safe and effective nonoperative treatment method to reduce and immobilise Gartland type II supracondylar fractures. Surgical treatment could be reserved for cases with unsatisfactory alignment or early loss of reduction following attempted nonoperative treatment.

Figures