Abstract
Gartland I supracondylar humerus fractures are non-displaced, stable injuries of the paediatric elbow. Optimal immobilisation aims to control pain and protect alignment while minimising disruption to children and families. This systematic review aims to review the currently available literature on immobilisation and casting options for Gartland I supracondylar fractures, summarising safety (displacement/complications), pain and functional recovery, satisfaction, and practical considerations. Across randomised and observational studies, type I supracondylar fractures rarely displace irrespective of immobilisation. Compared with collar-and-cuff alone, above-elbow posterior splints or backslabs reduce pain, analgesia use, and sleep disturbance, and accelerate return to activity. Removable (soft) casts and long-arm splints are non-inferior to rigid long-arm casts for radiographic and functional outcomes, while often improving convenience and parent and patient experience. Newer materials (waterproof or hybrid-mesh liners, biobased polyester, and 3D printed orthoses) further enhance comfort without compromising stability. In conclusion, for Gartland I supracondylar fractures, a well-applied above-elbow posterior splint or removable long-arm cast for around three weeks is typically sufficient. Collar-and-cuff alone is generally inferior for early symptom control. Innovative techniques and casting materials can be offered where available but may require further research to assess their outcomes. Application technique and education remain critical.