What is the initial management for a distal radial buckle fracture in a 9-year-old male?

Management of Distal Radial Buckle Fracture in a 9-Year-Old Male

A removable splint worn for 3 weeks is the recommended initial management for a distal radial buckle fracture in a 9-year-old male, with no need for routine follow-up radiographs or fracture clinic visits.

Understanding Buckle (Torus) Fractures

Buckle fractures are incomplete compression fractures without cortical disruption that are common in children 1. They represent stable fractures of the distal radius that occur typically after a fall onto an outstretched hand.

Treatment Algorithm

Initial Management

1. Immobilization Method:

   • Removable splint is the preferred treatment 2
   • The splint should be supplied in the emergency department
   • Patient/parents should be instructed on proper use and removal

2. Duration of Immobilization:

   • Wear the removable splint for 3 weeks 2
   • The splint can be removed for bathing and hygiene purposes

3. Follow-up Requirements:

   • No routine fracture clinic follow-up is necessary 2
   • No repeat radiological imaging is required once adequate information is provided at diagnosis

Evidence Supporting This Approach

The AAOS guidelines provide support for using removable splints in minimally displaced distal radius fractures 3. Specifically, Recommendation 8 states: "The use of removable splints is an option when treating minimally displaced distal radius fractures" with a recommendation strength classified as "Weak" 3.

Current research strongly indicates that torus fractures should be managed with removable splints rather than circumferential casts 2. This approach has been found to be:

• More cost-effective
• Preferred by children and families 4
• Associated with fewer complications
• Equally effective for fracture healing

Important Clinical Considerations

When to Consider Alternative Treatment

While removable splints are appropriate for typical buckle fractures, be alert for:

• Signs of displacement or angulation that exceeds acceptable parameters
• Evidence of associated injuries
• Unusual pain or swelling that might indicate a more complex injury

Patient Education

Provide clear instructions to parents/caregivers regarding:

• Proper use of the removable splint
• When to return (persistent pain, swelling, numbness)
• Expected timeline for recovery
• Activities to avoid during the healing period

Common Pitfalls to Avoid

1. Overtreatment: Avoid unnecessary casting for stable buckle fractures
2. Excessive imaging: Routine follow-up radiographs are not necessary and increase radiation exposure and healthcare costs
3. Overlooking neurovascular status: Always assess and document neurovascular status at initial evaluation
4. Misdiagnosis: Ensure proper diagnosis of a buckle fracture versus other fracture types that might require more aggressive management

Conclusion

Buckle fractures of the distal radius in children are stable injuries that heal reliably with minimal intervention. A removable splint for 3 weeks provides adequate immobilization while allowing for comfort and hygiene. This approach represents both an economical and resource-saving strategy for patients, parents, and the healthcare system while maintaining excellent clinical outcomes.