Management of Non-Displaced Buckle Fractures in Pediatric Patients
Non-displaced buckle fractures in children should be treated with a removable splint for 3 weeks without routine orthopedic follow-up or repeat radiographs. 1, 2
Immobilization Method
Use a removable splint rather than a circumferential cast. 1, 2, 3
- Removable splints are now the preferred treatment, with 69% of pediatric orthopedic surgeons using them as of 2020, representing a dramatic shift from only 29% in 2012 3
- For distal radius buckle fractures specifically, posterior splinting provides superior pain control compared to collar-and-cuff immobilization during the first 2 weeks after injury 1
- Circumferential casting in the emergency department carries an 11% complication rate (primarily skin-related issues) without any clinical benefit 4
- Removable devices are associated with shorter immobilization duration and fewer clinic visits without any cases of fracture displacement 5
Duration of Immobilization
- 55% of pediatric orthopedic specialists recommend 3 weeks or less of immobilization 3
- This duration is sufficient for stable buckle fractures, which are inherently stable injury patterns 3
Follow-Up Care
No routine orthopedic follow-up or repeat radiographs are necessary. 4, 2
- In a cohort of 309 pediatric wrist buckle fractures, no patients had fracture displacement identified on follow-up imaging 4
- 85% of pediatric orthopedic surgeons now use minimal follow-up protocols 3
- Primary care physician follow-up (rather than orthopedic specialist) is appropriate if any follow-up is deemed necessary, with 53% of emergency physicians referring to primary care 6
- Critical caveat: Adequate patient and family education at the time of diagnosis is essential when eliminating routine follow-up 2
Shared Decision-Making
Utilize shared decision-making when discussing management options. 3
- 85% of pediatric orthopedic specialists employ shared decision-making in treatment discussions 3
- This approach addresses parental concerns while adhering to evidence-based practice
Common Pitfalls to Avoid
- Misdiagnosis risk: Ensure the fracture is truly a buckle/torus pattern and not a more unstable fracture type that requires different management 3
- Overcasting: Avoid circumferential casts which increase complications without improving outcomes 4
- Unnecessary imaging: Repeat radiographs add no clinical value for confirmed buckle fractures 4, 2
- Excessive follow-up: Multiple orthopedic visits (67% had multiple visits in one study) represent unnecessary healthcare utilization 4
Application to Other Anatomic Sites
This simplified approach extends beyond distal radius fractures. 5