How are buckle fractures of the distal radial and ulnar metadiaphyses (forearm bones) typically managed?

Management of Buckle Fractures of Distal Radial and Ulnar Metadiaphyses

Buckle fractures of the distal radial and ulnar metadiaphyses can be safely and effectively managed with removable splints worn for 3 weeks, eliminating the need for routine follow-up appointments and repeat imaging. 1

What are Buckle Fractures?

• Buckle fractures (also called torus fractures) are incomplete compression fractures without cortical disruption that are common in children 2
• They typically occur at the metadiaphyseal junction of the distal radius and sometimes the ulna
• These fractures are inherently stable with minimal risk of displacement due to their compressive nature 3
• Most commonly caused by falls onto an outstretched hand 2

Recommended Management Approach

Immobilization Options

• Removable splints are the preferred treatment option for buckle fractures 3, 1

  • Higher patient/parent satisfaction and convenience compared to casting
  • Allows for bathing and hygiene
  • Can be removed at home after treatment period

• Rigid immobilization (casting) is suggested for displaced distal radius fractures but is unnecessary for stable buckle fractures 4

Duration of Immobilization

• Recommended immobilization period: 3 weeks 1, 5
• Parents can remove splints at home without need for clinical visit 5

Follow-up Requirements

• Routine clinical follow-up is not necessary once adequate information is provided at diagnosis 1
• Repeat radiological imaging is not required for uncomplicated buckle fractures 1

Patient Outcomes and Satisfaction

• Studies show high satisfaction rates with splint treatment (97.4% compared to 95.2% with rigid casting) 5
• Comfort levels are excellent with both methods, but slightly better with splints (95.7% vs 93.3%) 5
• Parents strongly prefer splint treatment over casting due to:
  • Ability to get the splint wet
  • Avoiding plaster saw for removal
  • Not requiring time off work for follow-up appointments 5

Special Considerations

• Associated ulnar fractures may occur in conjunction with distal radius fractures (approximately 6% of cases) 6
• Four morphological patterns of associated ulnar fractures have been identified, with simple extra-articular fractures being most common 6
• Most associated ulnar fractures can be managed conservatively along with the radial fracture 6

Potential Complications

• Cast/splint changes may be required (6.8% for soft casts vs 11.5% for rigid casts) 5
• The most common reason for changing rigid casts is getting them wet 5
• Re-fractures are extremely rare with proper management 5
• Limitation of forearm rotation may occur with certain fracture patterns, particularly with comminuted ulnar fractures 6

Cost and Resource Implications

• Management with removable splints represents both economic and resource savings for:
  • Patients and families
  • Healthcare systems
  • Reduced need for follow-up appointments 1

This evidence-based approach to buckle fractures represents a shift from traditional management with circumferential casting to more convenient and equally effective removable splinting, improving patient experience while maintaining excellent clinical outcomes.