Our study included children ages three to 12 years old, who sought care for an injury consistent with the diagnosis of a type 1 SCH fracture in the emergency department (ED) at BC Children’s Hospital. A non-inferiority study design was used to evaluate whether long-arm splint treatment resulted in comparable radiographic and functional outcomes to the standard above-elbow casting for this fracture type. National Institutes of Health (, #NCT01912365). This study received approval from the research ethics board at the treating center and was registered with the U.S. We conducted a RCT comparing long-arm splinting and above-elbow casting for Gartland’s type 1 SCH fractures in children. Due to recruitment and follow-up challenges, we have resolved to treat this as a pilot study that can inform future robust, multi-center RCTs. Our hypothesis was that the radiographic and functional outcomes of long-arm splinting would not be inferior to the above-elbow casting treatment. The objective of this randomized controlled trial (RCT) was to assess and compare the long-term radiographic and functional outcomes, complication rates, and patient-reported outcomes between long-arm splinting and above-elbow casting treatments for type 1 SCH fractures. To our knowledge, there are no studies comparing the efficacy of long-arm splinting to above-elbow casting for type 1 SCH fractures. suggests that long-arm splints can also be an effective treatment for type 1 SCH fractures. The most commonly preferred treatment for type 1 SCH fractures is circumferential casting with immobilization for three to four weeks. In both of these treatment methods, the elbow is immobilized in flexion at 90° with the forearm in a supine neutral position. Type 1 SCH fractures can be treated by a variety of immobilization methods, including long-arm splinting and above-elbow circumferential casting. Once the fracture is healed, motion of the limb should be allowed. Īs type 1 SCH fractures are stable, immobilization for one to four weeks will typically produce good functional outcomes. Type 1 SCH fractures do not involve any translation or rotation of the humerus, and under radiographic examination, the anterior humeral line transects the capitellum. The Gartland classification, which is the most widely used system for this type of fracture, categorizes non-displaced SCH fractures as type 1 of 4 based on fracture severity. ![]() Over 50% of all pediatric supracondylar humerus (SCH) fractures are non-displaced. Supracondylar fractures of the humerus are the most common type of elbow fracture seen in children, comprising 55–80% of pediatric elbow fractures and 3% of all childhood fractures. Preliminary findings suggest functional and radiological outcomes with splinting are non-inferior to casting however, a larger sample size is required to more accurately compare the two modalities. ![]() Complications reported in the splint group included device breakdown, a conversion to above-arm cast, and significant itchiness. The splint group obtained excellent Flynn’s criteria scores while the cast group reported good and excellent scores. The average change in Baumann’s angle at 6-month follow-up was 3° or less for each treatment arm. Due to lack of follow-up data at 6 months post-injury, five splint patients and 10 cast patients were included in the final cohort for data analysis. In total, 34 patients were enrolled in the study with 13 in the randomized arm and 21 in the observational arm. Baumann’s angle, functional assessment scores, and Flynn’s criteria score were measured at initial injury and at six months post-injury. Patients between three and 12 years old presenting with a type 1 SCH fracture were randomized into splint or cast groups, or an observational arm. ![]() The study was set up as a randomized controlled non-inferiority trial. The purpose of this study was to compare the radiographic and functional outcomes of long-arm splinting and above-elbow casting as the definitive treatment for children with type 1 SCH fractures. There is no consensus as to whether one treatment method is more effective than the other for this injury. Type 1 supracondylar humerus (SCH) fractures tend to heal well when immobilized by above-elbow casting or long-arm splinting.
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