What is the typical duration of casting for a 15-year-old male (YOM) with a subtle buckle fracture of the dorsal aspect of the left radial distal metaphysis?

Management of Subtle Buckle Fracture of Dorsal Aspect of Left Radial Distal Metaphysis in a 15-Year-Old Male

For a 15-year-old male with a subtle buckle fracture of the dorsal aspect of the left radial distal metaphysis, a removable splint for 3 weeks is the recommended treatment rather than a rigid cast. 1, 2

Treatment Approach

• Removable splints are recommended by the American Academy of Orthopaedic Surgeons (AAOS) as an appropriate option for treating minimally displaced distal radius fractures like buckle fractures 1
• Rigid immobilization (casting) is unnecessary for stable buckle fractures and should be reserved for displaced fractures 2
• Management with removable splints represents economic and resource savings for healthcare systems compared to casting 2

Duration of Immobilization

• The recommended duration of immobilization for buckle fractures is approximately 3 weeks 1, 3
• Radiographic follow-up should be performed at approximately 3 weeks to confirm adequate healing before discontinuing immobilization 1, 3
• Studies have shown that shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered for optimal outcomes 4

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 1, 3
• Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
• Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1, 3

Evidence Supporting Removable Splints vs. Casting

• Research has demonstrated that children treated with removable splinting have better physical functioning and less difficulty with activities than those treated with a cast 5
• Studies show higher levels of satisfaction, preference, and convenience with splints compared to casts on visual analog scales 6
• Splints allow for bathing, showering, or swimming, which is a significant advantage over rigid casts 7
• Parents have shown a preference for treatment with soft cast/splints over rigid casts, citing the ability to get the cast wet, avoidance of the plaster saw, and not having to take time off work for cast removal 7

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, 3
• For displaced fractures, rigid immobilization (casting) is preferred over removable splints 1, 2