What is the recommended treatment for pediatric acute radial neck buckle fractures?

Treatment of Pediatric Acute Radial Neck Buckle Fractures

For pediatric acute radial neck buckle fractures, immobilization with a posterior splint is the recommended treatment, as it provides better pain control and excellent outcomes without the need for surgical intervention. 1

Initial Management

• A radial neck buckle fracture is considered a stable fracture pattern that responds well to conservative management 1
• Posterior splinting is preferred over collar and cuff immobilization as it provides better pain relief within the first 2 weeks after injury 1
• Rigid immobilization is suggested over removable splints for better fracture stabilization and pain control 1

Treatment Algorithm Based on Age and Fracture Characteristics

For Children 9-11 Months Old

• Immobilization with posterior splint is sufficient if there is a history of fall while cruising or walking 1
• Skeletal survey is not necessary for distal radius/ulna buckle fractures in this age group with appropriate history 1

For Children 12-23 Months Old

• Posterior splint immobilization is the treatment of choice 1
• Skeletal survey is deemed inappropriate for distal radius/ulna buckle fractures in this age group, indicating the benign nature of these injuries 1

For Older Children

• Conservative management with posterior splinting for 3-4 weeks is recommended 2, 3
• Nonoperative treatment has shown excellent to good outcomes in 89% of cases that are amenable to casting alone 3

Prognostic Factors and Outcomes

• Younger children (under 10 years) tend to have better outcomes than older children with radial neck fractures 3
• Buckle fractures have the best prognosis among radial neck fracture types, with excellent healing potential 2, 3
• Complications are rare with appropriate immobilization of buckle fractures 2

Important Considerations and Pitfalls

• Distinguish buckle fractures from more severe radial neck fractures that may require reduction or surgical intervention 4, 3
• Avoid unnecessary manipulation of buckle fractures as they are stable by definition 2
• Monitor for pain control during the first 2 weeks of immobilization, as this is when patients experience the most discomfort 1
• Ensure proper positioning in the splint to maintain the fracture in anatomic alignment 1
• Follow-up radiographs are typically not necessary for uncomplicated buckle fractures 2

Duration of Immobilization

• 3-4 weeks of immobilization is typically sufficient for complete healing 2, 3
• Earlier mobilization may be considered for very stable, minimally displaced buckle fractures in younger children 3
• Physical therapy is rarely needed following immobilization for buckle fractures 2

By following these guidelines, pediatric radial neck buckle fractures can be effectively managed with excellent functional outcomes and minimal complications.