Backslab Versus Nonbackslab for Immobilization of Undisplaced Supracondylar Fractures

Abstract

Immobilization of supracondylar fractures of the humerus, for 1 to 4 weeks in a backslab or a collar and cuff, produces good functional outcomes. This study assesses the pain associated with these 2 forms of immobilization. A randomized controlled trial comparing above-elbow posterior fiberglass slab and broad arm sling, with collar and cuff immobilization without plaster slab, was conducted at a children's hospital emergency department. Patients presenting with undisplaced supracondylar fractures were enrolled and reviewed after 2 weeks of immobilization. A daily diary was used during immobilization to assess pain, resumption of normal activity of the child, and parental satisfaction. Pain was assessed using a 100-mm visual analog scale. Fifty patients were enrolled, of whom 27 were randomized to a slab and 23 were randomized to a collar and cuff. Immobilization in a slab was associated with a reduction in time to resumption of normal activity, while immobilized in the device, with a median of 2.0 days (interquartile range [IQR], 1.0-5.0 days) versus 7.0 days (IQR, 3.0-13.0 days; P = 0.01). For the slab group, the median duration of pain was 4.0 days (IQR, 1-8.0 days) versus 6.0 days (IQR, 5.0-9.5 days) for the collar and cuff group (P = 0.07). Median daily pain severity was 28 mm for the slab group versus 33 mm for the collar and cuff group (P = 0.21). Moreover, 96% of parents in the slab group and 83% in the collar and cuff group would use the immobilization again (P = 0.17). For supracondylar fractures, use of an above-elbow posterior slab produces shorter duration of pain and reduces the time taken to become active again.