What type of splint is recommended for a buckle fracture of the distal radial diaphysis?

Splint Type for Buckle Fracture of Distal Radial Diaphysis

A removable splint is the recommended treatment option for buckle fractures of the distal radial diaphysis, as it provides adequate immobilization while offering better patient satisfaction and convenience compared to casting. 1, 2

Treatment Approach

• Buckle (torus) fractures are inherently stable and at low risk for displacement, making them suitable for less restrictive immobilization options 3
• The American Academy of Orthopaedic Surgeons (AAOS) specifically recommends removable splints as an appropriate treatment option for minimally displaced distal radius fractures, including buckle fractures 1
• Prefabricated wrist splints have demonstrated higher levels of patient satisfaction, preference, and convenience compared to traditional casting in randomized controlled trials 4

Evidence Supporting Removable Splints

• A systematic review of the management of torus/buckle fractures found that current research strongly supports using removable splints supplied in the emergency department and worn for 3 weeks 2
• Randomized controlled trials comparing casts versus splints for distal radial buckle fractures have shown that splinted patients report higher levels of satisfaction and convenience on visual analog scales 4
• While pain scores were slightly higher in splinted groups in some studies, the differences were not statistically significant enough to outweigh the benefits of splinting 4

Duration of Immobilization

• The recommended duration for immobilization with a removable splint is approximately 3 weeks 1, 2
• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1

Follow-up Considerations

• Primary care physician follow-up is appropriate for buckle fractures treated with removable splints, with studies showing that 87.2% of patients successfully complete treatment without requiring specialty consultation 5
• There is evidence suggesting that after initial diagnosis and proper patient education, further clinical and radiological follow-up may not be necessary for uncomplicated buckle fractures 2, 6

Important Caveats

• This recommendation applies specifically to nondisplaced or minimally displaced buckle fractures of the distal radius 1
• If there is significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, more rigid immobilization or surgical management may be indicated 1
• Patients should be instructed to perform active finger motion exercises following diagnosis to prevent finger stiffness, which is one of the most functionally disabling complications 7
• Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1

Cost and Resource Considerations

• Using removable splints for buckle fractures has been shown to save both time and money compared to traditional casting approaches 6
• This approach reduces the number of required follow-up visits and radiographs, creating benefits for both patients and healthcare systems 2, 6