Splinting for Radial Buckle Fractures
For radial buckle fractures, a removable splint is the recommended immobilization method over casting, as it provides better physical functioning while maintaining adequate healing. 1
Recommended Immobilization Method
- Removable splints are specifically recommended by the American Academy of Orthopaedic Surgeons (AAOS) as an appropriate option for treating minimally displaced distal radius fractures, including buckle fractures 1
- Removable splints offer higher levels of patient satisfaction, convenience, and preference compared to casting, as demonstrated in randomized controlled trials 2
- Splinted patients report better physical functioning and less difficulty with daily activities (particularly bathing) than those treated with casts 3
Duration of Immobilization
- The recommended duration of immobilization for radial buckle fractures is approximately 3 weeks 1, 4
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
Important 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
- 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
When to Consider Alternative Treatment
- If there is any significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, rigid immobilization (casting) or surgical management may be indicated instead of removable splinting 1
- For displaced fractures, rigid immobilization (casting) is preferred over removable splints 1
Evidence Quality and Clinical Implications
- Multiple randomized controlled trials support the use of removable splints over casting for buckle fractures 2, 3
- Current evidence indicates that buckle fractures should be managed with a removable splint supplied in the emergency department and worn for 3 weeks 4
- While traditionally treated with circumferential casts, the evidence now strongly supports the use of removable splints for these inherently stable fractures 4
Common Pitfalls to Avoid
- Don't confuse buckle fractures with more unstable fracture patterns that require rigid immobilization 1, 5
- Avoid unnecessary prolonged immobilization beyond 3 weeks, as this can lead to stiffness without providing additional benefit 1, 4
- Don't overlook the importance of active finger motion exercises during the immobilization period 1