What is the treatment plan for a pediatric patient with an acute buckle fracture of the metaphysis of the distal ulna and radius?

Treatment Plan for Pediatric Acute Buckle Fracture of Metaphysis of Distal Ulna and Radius

Pediatric distal radius and ulna buckle fractures should be treated with a removable splint rather than a cast, as this approach provides better physical functioning while maintaining adequate fracture healing.

Initial Assessment and Diagnosis

• Standard radiographs are the initial imaging of choice to confirm the diagnosis and rule out associated fractures 1
• Multiple views should be obtained to properly visualize the fracture 1
• Buckle (torus) fractures are incomplete compression fractures without cortical disruption and are common in children 2

Treatment Approach

Recommended Immobilization Method

• Removable splint is preferred over casting for distal radius/ulna buckle fractures in children 3

  • Children treated with removable splinting demonstrate:
    • Better physical functioning at 14 days post-injury
    • Less difficulty with daily activities, particularly bathing
    • No difference in pain levels compared to casting
    • No increased risk of refracture

• The American Academy of Orthopaedic Surgeons guidelines support that distal radius/ulna buckle fractures in children can be managed with immobilization 2

Duration of Immobilization

• Average immobilization duration is approximately 3-4 weeks 1
• Clinical and radiographic reassessment should be performed at 2-3 weeks to evaluate fracture healing progression 1
• Children typically have faster healing rates than adults, potentially allowing for shorter immobilization periods 1

Special Considerations

• For children 9-11 months old with distal radius/ulna buckle fracture from a reported fall while cruising or walking, skeletal survey is not necessary 4
• For children 12-23 months old with distal radius/ulna buckle fracture, skeletal survey is judged inappropriate 4

Rehabilitation Protocol

• After the immobilization period (typically 3-4 weeks), implement:

  1. Active finger motion exercises to prevent stiffness 1
  2. Progressive range of motion exercises 1
  3. Strengthening exercises for intrinsic hand muscles 1

• Directed home exercise programs should be implemented after the immobilization period 1

• Full recovery is typically expected within 6-8 weeks 1

Pain Management

• NSAIDs are recommended for pain and inflammation control 1
• Ice application during the first 3-5 days can provide symptomatic relief 1
• Consider vitamin C supplementation for prevention of disproportionate pain 4, 1

Follow-up Care

• Clinical and radiographic reassessment at 2-3 weeks 1
• Monitor for signs of complications such as malunion or stiffness 1
• Ensure the splint does not compromise circulation by overtightening 1
• Seek immediate medical attention if the fractured extremity appears blue, purple, or pale 1

Advantages of Removable Splint vs. Cast

• Better physical functioning with splinting 3
• Less difficulty with activities of daily living, especially bathing 3
• Improved patient and family satisfaction 5
• Cost-effective approach 5
• No increased risk of complications compared to casting 3

This treatment approach balances the need for adequate immobilization while maximizing function and comfort, resulting in optimal outcomes for pediatric patients with buckle fractures of the distal radius and ulna.