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Pediatrics Case 10 ED Management

Management of these fractures is guided by Gartland staging system: 

Gartland Stage



Stage I

Nondisplaced fracture

Above-elbow cast

Stage II

Displaced and angulated; intact posterior cortex

Reduction, cast. If unstable after reduction, open reduction and pinning

Stage III

Complete displacement

Open reduction and pinning

  1. Gartland Stage I: a posterior mold splint with the elbow at <90˚ flexion is adequate. These casts tend to be on for 3-4 weeks, however patients should obtain interval imaging around 1 week after casting to assess for displacement.
  2. Gartland Stage II: a posterior mold splint may be adequate if the fracture is stable after reduction.
  3. Gartland Stage III, open reduction is needed. Orthopedic consultation is warranted for early followup and surgical evaluation in all patients. 

Patients with Garland Stage II or III fractures require ED orthopedics consultation to guide management decisions regarding reduction, operative management, and disposition for rapid follow up versus admission for serial vascular exams and compartment syndrome exams.