Management of Nondisplaced Buckle Fractures
For nondisplaced buckle fractures, treat with a removable splint for 3 weeks without routine follow-up or repeat radiographs, as these fractures are inherently stable with minimal risk of displacement.
Immobilization Method
Use a removable splint rather than a rigid cast for superior functional outcomes and patient satisfaction. 1, 2
- Removable splints provide better physical functioning compared to rigid casts, with significantly higher Activities Scales for Kids performance scores at 14 days post-injury 2
- Patients treated with splints report higher satisfaction, convenience, and preference on visual analog scales compared to those in casts 1
- Pain levels are comparable between splinting and casting, with no clinically significant differences 1, 2
- Splints allow for easier bathing and hygiene, with 94.9% of children able to bathe, shower, or swim while wearing soft casts 3
Splint Duration
- Immobilize for 3 weeks total 4, 3
- Parents can remove the splint at home after 3 weeks without requiring a clinic visit for removal 3
Follow-Up Requirements
No routine clinical or radiological follow-up is necessary once adequate information is provided at diagnosis. 4
- Buckle fractures are inherently stable with minimal risk of displacement 1, 5
- No refractures occurred in multiple randomized controlled trials comparing splints to casts 2, 3
- Eliminating routine follow-up represents significant cost and resource savings for patients, families, and healthcare systems 4
Patient Education
Provide comprehensive information at the time of diagnosis including:
- Expected healing timeline (3 weeks of immobilization) 4
- Instructions for splint removal at home after 3 weeks 3
- Warning signs requiring medical attention (though complications are extremely rare) 5
- Activity modifications during the healing period
Evidence Quality
This recommendation is supported by:
- High-quality evidence from multiple randomized controlled trials demonstrating safety and effectiveness of removable splints for buckle fractures 4, 5
- Systematic reviews confirming that buckle fractures can be managed with minimal intervention without adverse outcomes 4, 5
- No cases of worsening angulation or displacement reported in buckle fractures treated with removable splints 5
Common Pitfalls to Avoid
- Avoid routine radiological follow-up as it provides no clinical benefit and increases healthcare costs 4
- Avoid rigid circumferential casts as they offer no advantage over removable splints and decrease patient satisfaction 1, 2
- Avoid scheduled fracture clinic appointments for uncomplicated buckle fractures, as they are unnecessary 4, 3