Treatment of Nondisplaced Buckle Fracture Deformity of the Distal Radial Metaphysis
A removable splint is the recommended treatment for a nondisplaced buckle fracture deformity of the distal radial metaphysis. 1, 2
Treatment Approach
- Buckle (torus) fractures are inherently stable compression fractures without cortical disruption, making them ideal candidates for less restrictive immobilization 2
- The American Academy of Orthopaedic Surgeons (AAOS) specifically recommends removable splints as an appropriate option for treating minimally displaced distal radius fractures 1
- Removable splints provide adequate stabilization while offering several advantages over traditional casting for these stable fractures 3
Benefits of Splint Treatment
- Patients treated with splints report higher levels of satisfaction, preference, and convenience compared to those treated with casts 3
- Splints allow for easier hygiene maintenance and the ability to remove the immobilization for bathing 3
- While pain scores may be slightly higher initially with splints compared to casts, this difference is generally not statistically significant 3
Duration of Immobilization
- Typical immobilization period for buckle fractures is 3-4 weeks 2, 4
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
Follow-up Protocol
- Initial follow-up can be managed by a primary care physician rather than requiring orthopedic specialist visits 5
- Studies show that 87.2% of children with distal radius buckle fractures successfully complete treatment with primary care follow-up only 5
- Almost all patients (98.8%) return to usual activities within 4 weeks of injury 5
Important Considerations
- Buckle fractures should be distinguished from greenstick fractures, which have cortical disruption and may require different management depending on the degree of angulation 2
- While buckle fractures are more common in children, they can occasionally occur in adults and should be considered in the differential diagnosis of wrist pain following trauma 4
- Long-term prognosis for nondisplaced buckle fractures is excellent, with patients typically becoming fully asymptomatic after proper treatment 6
When to Consider Alternative Treatment
- If there is any significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 1, 7
- For displaced fractures, rigid immobilization (casting) is preferred over removable splints 1, 7
- Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 7