Splinting of buckle fractures of the distal radius in children
Date First Published:
July 12, 2004
Last Updated:
January 25, 2008
Report by:
Marten C Howes, Consultant (Emergency Department, Royal Adelaide Hospital)
Search checked by:
Peter Cutting, Consultant and Martin Thomas, Consultant, Emergency Department, Royal Adelaide Hospital
Three-Part Question:
In [a child with a buckle fracture of the distal radius] does [immobilisation in a plaster cast or symptomatic bracing] offer better [pain relief and functional recovery]?
Clinical Scenario:
A seven year old girl presents having fallen onto her out-stretched hand. X-ray shows a typical buckle fracture of the distal radius, minimally displaced. The department protocol stipulates immobilisation in a full below-elbow cast for 4 weeks with regular fracture clinic follow-up but you remember that in your last job the orthopaedic surgeons preferred removable splints and symptomatic treatment, with no follow-up. You wonder if your current department is behind the times, or if your previous department was recklessly negligent!
Search Strategy:
Medline to November Week 2 2007and EMBASE 1980 to 2008 Week 01 via the Ovid interface
The Cochrane Library Issue 4 2007
The Cochrane Library Issue 4 2007
Search Details:
child.mp OR children.mp or exp child/ OR pediatric$.mp OR exp pediatrics/ OR paediatric.mp] AND [exp casts, surgical/ OR plaster$.mp OR cast$.mp OR brace$.mp OR exp braces/ OR splint$.mp OR exp splints/] AND exp fractures, closed/ OR exp ulna fractures/ OR exp radius fractures/ OR buckle.mp OR torus.mp OR exp wrist injuries/ OR wrist fractur$.mp OR exp forearm injuries/ OR exp forearm/ OR forearm.mp] LIMIT to human and English Language.
Cochrane: (buckle fracture):ti,ab,kw
Cochrane: (buckle fracture):ti,ab,kw
Outcome:
1448 papers were identified. Review of the abstracts excluded the majority as being irrelevant to the question. 3 papers were identified as relevant and of sufficient quality, 1 of which was the update of another. The 2 remaining papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Simple treatment for torus fractures of the distal radius Davidson JS, Brown DJ, Barnes SN, Bruce CE 2001 UK | 179 children aged 2 – 15 with torus fractures of the distal radius, Futura splint (98) vs plaster cast (81) |
PRCT | Descriptive | All fractures united clinically with no loss of position | Randomised by day of attendance. Results narrative |
| A Randomized Controlled Trial of Splinting versus Casting for Wrist Buckle Fractures in Children. Plint AC, Perry AA, Correll R et al. 2006, Canada | 87 children aged 6 – 15 years with distal radius buckle fractures. Removable splint (42) vs cast (45) |
PRCT | Activities Scale for Kids performance (ASKp) at 14 days | 93.77 vs 89.29 (p=0.041) |
Author Commentary:
Authors describe the non-union of buckle fractures as occurring "almost never" - therefore the main outcomes investigated were cost, comfort, and parental satisfaction.
Bottom Line:
Removable braces support healing as much as casts and promote earlier functional recovery in children with distal buckle wrist fractures
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Davidson JS, Brown DJ, Barnes SN, Bruce CE. Simple treatment for torus fractures of the distal radius
- Plint AC, Perry AA, Correll R et al.. A Randomized Controlled Trial of Splinting versus Casting for Wrist Buckle Fractures in Children.