When to Begin Wrist ROM After Pediatric Buckle Fracture
Pediatric patients with nondisplaced distal radius buckle fractures do not need early wrist range of motion exercises and can begin wrist ROM after 3 weeks of immobilization, though finger motion should start immediately.
Immediate Management: Finger Motion Only
Active finger motion exercises should begin immediately following diagnosis to prevent hand stiffness, which is one of the most functionally disabling complications of distal radius fractures 1.
Finger motion does not adversely affect an adequately stabilized distal radius fracture regarding reduction or healing 1.
Instructing patients at the first encounter to move fingers regularly through complete range of motion is extremely cost-effective and prevents complications that are difficult to treat after fracture healing 1.
Wrist ROM Timing: Not Routinely Needed Early
Early wrist motion is not routinely necessary following stable fracture fixation, as buckle fractures are inherently stable injuries 1, 2.
For surgically stabilized distal radius fractures, wrist mobilization typically begins at 1-3 weeks depending on fixation method 1, but buckle fractures are treated conservatively with immobilization only.
Immobilization Duration
Buckle fractures should be immobilized for 3 weeks with a removable splint 3.
The majority (69%) of pediatric orthopedic specialists now use removable wrist splints for 3 or fewer weeks (55%), representing a dramatic shift from more aggressive treatment approaches 3.
These fractures are stable axial compression-type metaphyseal fractures that require only brief immobilization 4.
Return to Activities
Almost all patients (98.8%) return to usual activities within 4 weeks of injury 5.
Wrist ROM exercises can reasonably begin after the 3-week immobilization period ends, coinciding with splint removal and return to normal activities.
Key Clinical Pitfalls
Do not restrict finger motion - failure to encourage early finger motion leads to significant stiffness that requires multiple therapy visits and possibly surgical intervention 1, 6.
Buckle fractures do not displace during healing - no cases of fracture displacement were identified on follow-up in studies of these injuries 7.
Overcasting these stable fractures poses unnecessary risk - 11% of children casted in the ED experienced cast complications 7.