We suggest nonsurgical immobilization of the injured limb for patients with acute (e.g. Gartland Type I) or non displaced pediatric supracondylar fractures of the humerus or posterior fat pad sign.

Rationale
Gartland Type I or non-displaced pediatric supracondylar humeral fractures are fractures without significant distortion of anatomical bony landmarks of the supracondylar region and can be associated with posterior fat pad sign. Non-operative immobilization of these fractures is common practice. 

This recommendation is based on two moderate quality studies that analyzed collar and cuff immobilization versus back-slab (posterior splint) immobilization for non-displaced pediatric supracondylar humeral fractures. Ballal, et al. was a prospective double-cohort study with a total of 40 patients and 20 in each group (collar and cuff versus back slab). Oakley, et al presented a randomized control trial with similar comparison groups and had a total of 50 patients (27 randomized to a posterior slab group and 23 to a collar and cuff). The randomized controlled trial was classified as moderate quality (see below for quality evaluation). Both of these prospective studies found better pain relief within the first two weeks of injury with the posterior splint/ back slab method of immobilization. The critical outcomes not reported include cubitus varus, hyperextension and loss of reduction.
  1. (22) Oakley E, Barnett P, Babl FE. Backslab versus nonbackslab for immobilization of undisplaced supracondylar fractures: a randomized trial. Pediatr Emerg Care 2009;25(7):452-456.
  2. (23) Ballal MS, Garg NK, Bass A, Bruce CE. Comparison between collar and cuffs and above elbow back slabs in the initial treatment of Gartland type I supracondylar humerus fractures. J Pediatr Orthop B 2008;17(2):57-60.