A Randomized, Controlled Trial of Removable Splinting Versus Casting for Wrist Buckle Fractures in Children

Plint, Amy C.; Perry, Jeffrey J.; Correll, Rhonda; Gaboury, Isabelle; Lawton, Louis

doi:10.1542/peds.2005-0801

Cited by 127 publications

(124 citation statements)

References 17 publications

(30 reference statements)

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“…We found that in all the children with torus fractures, cast immobilization was successful, with no displacement and no complications, so that the inclusion of additional radiographs during management or after cast removal would have had no added benefit. These results support previous studies indicating that forearm torus fractures in children may be safely treated using a wrist splint that can be removed at home by the parents [12][13][14].…”

Section: Discussionsupporting

confidence: 91%

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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Introduction A prospective pooled case series was used to assess the value of frequent radiographic examinations during treatment of closed forearm fractures in children from major university pediatric medical centers in Israel and China. Methods The sample consisted of 202 consecutive children (mean age 7 years; range 3-12 years) with closed forearm fractures treated nonoperatively. Children with open, growth-plate fractures or fractures associated with dislocation of the nearby joint (i.e., monteggia fractures) were excluded. In 28 children who had torus fractures, radiographic examination was performed at the time of cast removal, 3 weeks after the start of treatment. In 63 children who had stable fractures that did not require reduction (undisplaced or minimally displaced, complete or greenstick), radiographic examination was performed 1 week after the start of treatment and again at cast removal 4-6 weeks later. In the remaining 111 children with complete, displaced, or greenstick fractures (all with angulation of more than 15°) who underwent closed reduction, an additional X-ray was taken 2 weeks after cast placement. All children (except those with torus fractures) were followed clinically, without further radiographic examination, for 3 months after cast removal. Results Radiographs at cast removal showed good union in all stable fractures, indicating that additional X-rays on cast removal would have had no added value. In the children with unstable fractures, only 9 showed redisplacement with angulation of more than 15°on repeated X-rays during the first 2 weeks after cast placement. All 9 underwent successful re-reduction. On clinical evaluation 3 months after cast removal, all patients in the sample had full range of elbow and forearm motion. Repeated fracture did not occur in any of the patients. Conclusions On the basis of these results, radiographs are recommended 2 weeks after cast placement for greenstick or complete fractures. At the time of cast removal, if clinical examination does not show signs of nonunion or malalignment, no radiographic examination is necessary.

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Section: Discussionsupporting

confidence: 91%

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Chen

Katz

Weigl

et al. 2008

Journal of Children's Orthopaedics

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“…Thus, evidence from this research combined with the advantages of the splint support the use of this device in the treatment of these fractures. The use of splinting instead of casting has been previously established for buckle fractures of the distal radius in children [13][14][15][16] and Colles fractures in adults. 11,12 Our results contribute to the growing body of evidence that splinting is a suitable alternative to casting for specific fractures of the distal radius.…”

Section: Discussionmentioning

confidence: 99%

“…This modified scale has been used in another trial assessing wrist function after fracture. 15 The scale has been found to be highly reliable, 19,20 have excellent construct validity and be responsive to change. [17][18][19][20] It has been validated in populations of children 5 to 15 years old with fractures and other musculoskeletal problems.…”

Section: Outcome Measuresmentioning

confidence: 98%

“…8−10 Finally, there is the need for specialized resources for application and removal of the cast. Preliminary evidence from studies involving adults 11,12 and studies of stable buckle fractures of the distal radius [13][14][15][16] suggest that splinting offers a safe alternative. However, this approach needs to be compared with the traditional use of casting in children who have minimally angulated and potentially unstable fractures of the distal radius before it can be recommended for clinical practice.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Boutis¹,

Willan²,

Babyn³

et al. 2010

Canadian Medical Association Journal

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“…1 Despite their high frequency, these fractures represent very stable injuries with excellent prognosis. 2 As a result, extensive evidence recommends their treatment with a removable wrist splint, rather than the traditional use of casting. [2][3][4][5][6][7][8] After the initial diagnosis and treatment, most of these fractures are managed by orthopedic surgeons.…”

mentioning

confidence: 99%

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

Koelink

Schuh²,

Howard³

et al. 2016

Pediatrics

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OBJECTIVES: Our main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.METHODS: This prospective cohort study was conducted at a tertiary care pediatric emergency department (ED). Eligible children were aged 2 to 17 years with a distal radius buckle fracture treated with a removable splint and referred to the PCP for reassessment. We telephoned families 28 days after their ED visit. The primary outcome was the proportion who received PCP follow-up exclusively. We also measured the proportion who received PCP anticipatory guidance and those children who reported returning to usual activities "always" by 4 weeks. RESULTS:We enrolled 200 children, and 180 (90.0%) received telephone follow-up. Of these, 157 (87.2% [95% confidence interval: 82.3 to 92.1]) received PCP follow-up exclusively. Specifically, 11 (6.1%) families opted out of physician follow-up, 5 (2.8%) self-referred to an ED, and the PCP requested specialty consultation in 7 (3.9%) cases. Of the 164 with a PCP visit, 77 (47.0%) parents received anticipatory guidance on return to activities for their child, and 162 (98.8%) reported return to usual activities within 4 weeks. CONCLUSIONS:The vast majority of children with distal radius buckle fractures presented to the PCP for follow-up and did not receive additional orthopedic surgeon or ED consultations. Despite a suboptimal rate of PCP advice on return to activities, almost all parents reported full return to usual activities within 4 weeks.

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A Randomized, Controlled Trial of Removable Splinting Versus Casting for Wrist Buckle Fractures in Children

Abstract: Children treated with removable splinting have better physical functioning and less difficulty with activities than those treated with a cast.

Cited by 127 publications

References 17 publications

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Are frequent radiographs necessary in the management of closed forearm fractures in children?

Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

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