Undisplaced fractures of the distal third of the radius in children: an innocent fracture?

Schranz, Peter; Fagg, Phillip S.

doi:10.1016/s0020-1383(05)80036-1

Cited by 23 publications

(12 citation statements)

References 10 publications

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“…8 We question whether the high displacement rate quoted in an earlier study in fact represents displacement of greenstick fractures rather than buckle fractures. 9 Other studies of wrist buckle fractures have also shown no evidence of fracture displacement. [1][2][3]…”

Section: Discussionmentioning

confidence: 96%

“…4 Although orthopedic texts and several articles refer to buckle fractures as inherently stable, 1,3,[6][7][8] one study did suggest that 7% of patients with buckle fractures had subsequent displacement. 9 A refracture rate of 2% has been quoted for all forearm fractures, 8 but the risk of refracture for wrist buckle fractures remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric wrist buckle fractures: Should we just splint and go?

Plint

Perry

Tsang

2004

CJEM

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Objectives: The objective of this study was to evaluate the utility of circumferential casting in the emergency department (ED), orthopedic follow-up visits, and radiographic follow-up in the management of children with wrist buckle fractures. Methods: We performed a retrospective medical record review of all children < 18 years of age who presented to our tertiary care children’s hospital between July 1, 2000, and June 30, 2001, and were diagnosed with a fracture of the wrist, radius or ulna. Based on the radiology reports, we identified buckle fractures of the distal radius, the distal ulna, or both bones. We excluded children who had other types of fractures. Results: We identified 840 children with fractures of the wrist, radius, or ulna. Of these, 309 met our inclusion criteria. The median age of our study cohort was 9.2 years. Emergency physicians immobilized 269 of these fractures in circumferential casts; of these, 30 (11%) had cast complications. Of the 276 subjects who had orthopedic follow-up visits and radiographs, 184 (67%) had multiple visits and 127 (46%) had multiple radiographs performed. No subjects had fracture displacement identified on follow-up. Conclusions: Orthopedic follow-up visits and radiographic follow-up may have minimal utility in the treatment of pediatric wrist buckle fractures. ED casting may pose more risk than benefit for these children. Splinting in the ED with primary care follow-up appears to be a reasonable management strategy for these fractures. A prospective study comparing ED splinting and casting for pediatric wrist buckle fractures is needed.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Pediatric wrist buckle fractures: Should we just splint and go?

Plint

Perry

Tsang

2004

CJEM

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“…Many authors feel that the refracture rates of these injuries are exceedingly low, regardless of the treatment [3][4][5][6][7][8][9][10]. The one study showing a rate of refracture of 7.1% for buckle fractures has never been replicated [13]. A retrospective review by Plint et al [3] found zero refractures in 309 patients with buckle fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Median time to refracture for all forearm fractures in children has been estimated to be 8-16 weeks after cast removal [11,12]. For forearm buckle fractures, one often cited study has estimated a refracture rate of 7.1% [13].…”

Section: Introductionmentioning

confidence: 99%

Does degree of immobilization influence refracture rate in the forearm buckle fracture?

Kennedy

Slobogean

Mulpuri

2010

Journal of Pediatric Orthopaedics B

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The aim of this study was to determine whether the degree of immobilization (method, extent, duration of treatment) affects the risk of refracture in the management of forearm buckle fractures. We performed a comprehensive systematic review of prospective trials using accepted epidemiological methods. Studies were selected in step-wise manner, in duplicate, with critical appraisal of identified studies. Results are presented in a summary table with primary and secondary outcomes described.Of the 869 studies identified by the search strategy, five studies met all eligibility criteria. 455 participants were included. No refractures were reported in any of the studies during the treatment period, regardless of degree of immobilization. One study followed patients for 6 months and found no late refractures in 75 participants. In conclusion, treatment in a removable splint does not increase risk of refracture or late displacement during the treatment period for buckle fractures of the distal forearm.Long-term data on refracture rate is limited. There tends to be improved function, patient acceptance, and caregiver satisfaction with the use of removable splints. Further study is needed to determine whether there are differences for longer periods of follow-up on a population basis.

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“…Many authors consider buckle fractures to be stable (Farbman et al 1999, Symons et al 2001, Solan et al 2002), but one study reported 7% subsequent displacement among buckle fractures (Schranz and Fagg 1992). Greenstick fractures are less stable.…”

Section: Introductionmentioning

confidence: 99%

Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures

Randsborg

Sivertsen

2009

Acta Orthopaedica

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Background and purpose Numerous follow-up visits for wrist fractures in children are performed without therapeutic consequences. We investigated the degree to which the follow-up visits reveal complications and lead to change in management. The stability of greenstick and buckle fractures of the distal radius was assessed by comparing the lateral angulation radiographically.Patients and methods The medical records of 305 distal radius fractures in patients aged less than 16 years treated at our institution in 2006 were reviewed, and any complications were noted. The fracture type was determined from the initial radiographs and the angulation on the lateral films was noted.Results Only 1 of 311 follow-ups led to an active intervention. The greenstick fractures had more complications than the buckle fractures. The lateral angulation of the buckle fractures did not change importantly throughout the treatment. The greenstick fractures displaced 5° on average, and continued to displace after the first 2 weeks. On average, the complete fractures displaced 9°.Conclusion Buckle fractures are stable and do not require follow-up. Greenstick fractures are unstable and continue to displace after 2 weeks. Complete fractures of the distal radius are uncommon in children, and highly unstable. A precise classification of fracture type at the time of diagnosis would identify a smaller subset of patients that require follow-up.

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Undisplaced fractures of the distal third of the radius in children: an innocent fracture?

Cited by 23 publications

References 10 publications

Pediatric wrist buckle fractures: Should we just splint and go?

Pediatric wrist buckle fractures: Should we just splint and go?

Does degree of immobilization influence refracture rate in the forearm buckle fracture?

Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures

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