Removable Splint for Buckle Fracture of Distal Radial Diaphysis
For buckle fractures of the distal radial diaphysis, a removable splint is the recommended treatment option due to its superior patient satisfaction, convenience, and comparable outcomes to casting. 1, 2
Recommended Treatment Approach
- Removable splints are the preferred immobilization method for nondisplaced buckle fractures of the distal radius, as recommended by the American Academy of Orthopaedic Surgeons 1
- Buckle (torus) fractures are inherently stable with low risk of displacement, making them ideal candidates for less restrictive immobilization options 3, 2
- Prefabricated wrist splints have demonstrated higher levels of patient satisfaction, preference, and convenience compared to casting in randomized controlled trials 4
Duration of Immobilization
- The recommended duration of immobilization for buckle fractures is approximately 3 weeks 1, 5
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
- Almost all patients report full return to usual activities within 4 weeks of injury 6
Clinical Considerations
- Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of distal radius fractures 7
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 7
- Early wrist motion is not routinely necessary following stable fracture fixation 7
Important Caveats and Exceptions
- If there is any significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, a more rigid immobilization or surgical management may be indicated instead of a removable splint 1
- Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
- While some practitioners may still use circumferential casting for these fractures, current evidence supports the use of removable splints with comparable clinical outcomes and greater patient satisfaction 2, 5
Follow-up Protocol
- Primary care physician follow-up is appropriate for most buckle fractures, with studies showing that 87.2% of patients do not require additional orthopedic or emergency department consultations 6
- Some evidence suggests that a single follow-up visit to confirm diagnosis and provide appropriate advice may be sufficient, without the need for further clinical visits 5
- Parents should be educated about the expected timeline for healing and when to return to activities 6