Treatment of Undisplaced Buckle Fracture of Distal Radius in a 13-Year-Old
Treat with a removable splint for 3 weeks, followed by a single follow-up visit to confirm healing, then allow return to normal activities. 1
Immobilization Method
- Use a removable wrist splint rather than a rigid plaster cast for this undisplaced buckle fracture, as recommended by the American Academy of Orthopaedic Surgeons for minimally displaced distal radius fractures 1
- Removable splints are equally effective as rigid casts for buckle fractures, with no difference in healing outcomes 2, 3
- Soft/removable casts offer practical advantages: children can bathe and shower while wearing them, parents can remove them at home after 3 weeks, and they avoid the need for plaster saw removal 3
- Parents overwhelmingly prefer removable splints over rigid casts, and satisfaction rates exceed 95% 3
Duration and Follow-Up
- Immobilize for 3 weeks total 1, 2
- Schedule radiographic follow-up at approximately 3 weeks to confirm adequate healing 1
- After confirming healing, no additional follow-up visits are necessary 2
- Primary care physician follow-up is appropriate and effective for these injuries, with 87% of families successfully managing care without orthopedic consultation 4
Activity Recommendations
- Initiate active finger motion exercises immediately after diagnosis to prevent stiffness, which is one of the most functionally disabling complications of distal radius fractures 1
- Finger motion does not adversely affect healing of adequately stabilized distal radius fractures 1
- Nearly all children (98.8%) return to usual activities within 4 weeks of injury 4
- Parents should receive clear anticipatory guidance on when their child can return to sports and activities (typically after the 3-week follow-up confirms healing) 4
Key Pitfalls to Avoid
- Confirm this is truly an undisplaced buckle fracture before proceeding with conservative management—if there is >3mm displacement, >10° dorsal tilt, or intraarticular involvement, more aggressive treatment is required 1
- Do not routinely order multiple follow-up radiographs or clinic visits, as a single 3-week check is sufficient for uncomplicated buckle fractures 2
- Ensure parents understand how to properly apply and maintain the removable splint 3
- Monitor for immobilization-related complications (skin irritation, muscle atrophy), which occur in approximately 14.7% of cases 1