Limited evidence to support removable splintage for wrist buckle fractures in children

Clinical question: 
How effective is removable splintage for undisplaced wrist compression (buckle) fractures in children?
Bottom line: 
Four trials compared removable splintage versus a traditional below-elbow cast. There was no short term deformity recorded in all 4 trials, and, in one trial, no refracture at 6 months. Parents strongly favoured removable casts.The review also included other intervention trials for wrist buckle fractures, including trials of below-elbow versus above-elbow casts. No difference in redisplacement of reduced fractures or cast-related complications were found, but below-elbow casts were less restrictive during use and avoided elbow stiffness. One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity. Three trials found percutaneous wiring significantly reduced redisplacement and remanipulation but one of these found no advantage in function at 3 months.
Caveat: 
Some of the trials used poor methods that meant their results were potentially unreliable. Although subcutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including fracture were not established.
Context: 
Approximately one third of all fractures in children occur at the wrist as a result of falling onto an outstretched hand. Some fractures are relatively minor, involve a bulging of the bone surface (buckle fractures) and are traditionally treated with a below-elbow plaster cast. Where there is bone displacement, treatment usually involves an above-elbow cast or surgical fixation.
Review CD#: 
CD004576
PEARLS No: 
98
Date: 
September, 2008
Authored by: 
Brian R McAvoy