Buckle Fractures of the Distal Radius Are Safely Treated in a Soft Bandage

West, Simon C.; Andrews, Jeffrey C; Bebbington, Andrew; Ennis, O.; Alderman, P. M.

doi:10.1097/01.bpo.0000152909.16045.38

Cited by 86 publications

(80 citation statements)

References 4 publications

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“…2 X-ray and ultrasound appearance of the same fracture at 6 weeks. Note the appearance of callus as seen on ultrasonography metaphysis of the bone, which is a point of decreased strength [14]. Greenstick fractures occur in the same way, but more severe forces are applied, and the disruption of one cortex occurs while the other is bent [7].…”

Section: Discussionmentioning

confidence: 97%

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Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

Pountos

Clegg

Siddiqui

2010

Journal of Children's Orthopaedics

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Objective The management and the diagnostic modalities used in cases of undisplaced greenstick and torus fractures of the distal radius in children vary between different treatment centres. The aim of this study was twofold: firstly, to analyse the sensitivity of X-rays versus ultrasound to diagnose these fractures; secondly, to compare three available treatment options (plaster cast, Futuro splints, and double Tubigrip) in terms of pain, analgesia requirements, grip strength, deformity, stiffness and interference with a child's activities of daily living. Methods We prospectively included 79 patients suffering from undisplaced greenstick and torus fractures of the distal radius. Patients were randomized (single blindly) to the studied treatment groups. Results In terms of diagnosis, the ultrasound was found to be more sensitive than X-rays for diagnosing these fractures. Our results also showed that Tubigrip was superior in terms of interference with a child's ADLs, stiffness and grip strength. However, there was no difference in the levels of pain, analgesia required, and deformity.Conclusion These results support the idea that ultrasound is an effective and sensitive tool for detecting undisplaced greenstick and torus fractures of the distal radius in children. Treating these fractures with functional nonrigid devices (Tubigrip) results in improved function without increased discomfort or deformity.

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Section: Discussionmentioning

confidence: 97%

“…Alternative treatments include removable splints [13], wool and bandage [14], or soft tubular elasticated bandage (i.e. Tubigrip).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

Pountos

Clegg

Siddiqui

2010

Journal of Children's Orthopaedics

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“…Other studies have found a similar frequency and type of misdiagnosis by ED physicians when considering this injury. 2,7 Nevertheless, healing of these more complex injuries is excellent because the distal radius has one of the highest capacities for remodeling. 25 An intervention by an orthopedic surgeon is rarely required, [25][26][27] and these fractures can generally be safely treated by using a splint.…”

Section: Figurementioning

confidence: 99%

“…Based on PCP knowledge of managing these injuries, 7,10,20,21 we estimated that 90% of participants would receive follow-up with the PCP exclusively. Therefore, assuming a primary outcome proportion of 0.90 and a 95% confidence interval (CI) precision of ±0.05 yields a minimum number of 158 patients (PASS, 2011; NCSS, LLC, Kaysville, UT).…”

Section: Data Analysesmentioning

confidence: 99%

“…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. 9 Given that intervention by an orthopedic specialist is rarely required for these fractures, it may also be appropriate to have these low-risk injuries followed up by the primary care provider (PCP).…”

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confidence: 99%

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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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Interventions for treating wrist fractures in children

Abraham

Handoll

Khan³

2008

Cochrane Database of Systematic Reviews

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Limited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established. Further research is warranted on the optimum approach, including splintage, for buckle fractures; and on the use of below-elbow casts and indications for surgery for displaced wrist fractures in children.

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Buckle Fractures of the Distal Radius Are Safely Treated in a Soft Bandage

Cited by 86 publications

References 4 publications

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

Interventions for treating wrist fractures in children

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