Supine position for casting

Before treatment discuss the following information with the patient/parents/caretakers:

• Nature of the injury
• The chosen treatment and why a particular treatment is selected
• Alternative treatments
• General operative risks
• Expected healing time
• Functional recovery
• Implant removal

Consider if the planned closed reduction is likely to be the definitive fracture management. If there is a high likelihood of internal fixation it may be better to start the procedure in an operating room instead of an emergency department.

Personnel need to know and confirm:

• Consent form, completed and signed
• Site and side of fracture
• Type of reduction planned
• Operative site has been marked by the surgeon
• Condition of soft tissues
• Patient positioning
• Comorbidities, including allergies

• General anesthesia
• Conscious sedation
• Local nerve block or regional anesthesia is rarely used alone in children
• Combination of nerve block and light general anesthesia

Position the patient supine and optionally place the forearm in finger traps.

If necessary, apply a strap with weight over the middle third of the humerus to provide additional traction.

If tubular bandage is to be used, position it before applying finger traps and traction.

If available use a mini-C-arm in a horizontal position which can be rotated to take orthogonal views without moving the arm.