What is the recommended treatment for a buckle fracture of the ulnar metaphysis?

Treatment of Buckle Fractures of the Ulnar Metaphysis

For buckle fractures of the ulnar metaphysis, removable splinting is recommended over casting as it provides better physical functioning while maintaining adequate healing.

Recommended Treatment Approach

• Removable splinting is the preferred treatment for stable buckle fractures of the ulnar metaphysis, as it allows for better physical functioning compared to rigid immobilization 1, 2
• Children treated with removable splints demonstrate significantly better physical functioning and less difficulty with daily activities than those treated with casts 2
• Rigid immobilization (casting) is unnecessary for stable buckle fractures and should be reserved for displaced fractures 1

Clinical Benefits of Removable Splinting

• Removable splinting results in:
  • Better physical functioning at 14 days post-injury 2
  • Less difficulty with bathing and other activities of daily living 2
  • No significant difference in pain compared to casting 2
  • No increased risk of refracture compared to casting 2

Duration of Treatment

• Typical immobilization period is 3 weeks, though this may vary based on clinical assessment 2
• After the immobilization period, the splint can be removed without requiring a clinical visit for removal 1

Special Considerations

• In very young children (under 3 years), careful assessment of the distal radioulnar joint (DRUJ) stability is important, especially if the buckle fracture is associated with a displaced distal metaphyseal ulnar fracture 3
• If there are concerns about DRUJ instability (suggesting a possible Galeazzi-equivalent injury), more aggressive treatment and closer follow-up may be warranted 3

Economic and Resource Implications

• Management with removable splints represents economic and resource savings for healthcare systems compared to casting 1
• Removable splinting eliminates the need for cast removal visits, reducing healthcare utilization 1, 2

Important Caveats

• This recommendation applies specifically to stable buckle fractures of the ulnar metaphysis 1
• More complex fracture patterns, such as displaced fractures or those with associated injuries, may require different management approaches 3
• If plastic deformation or significant displacement is present, more aggressive treatment may be needed 4