Treatment Recommendation for Minimally Displaced Pediatric Distal Radius Fractures
A removable splint is the recommended treatment for minimally displaced pediatric distal radius fractures, particularly buckle fractures, as endorsed by the American Academy of Orthopaedic Surgeons. 1
Treatment Approach
Primary Immobilization Strategy
Removable splints are appropriate and preferred over rigid casting for minimally displaced distal radius fractures in children, offering equivalent healing outcomes with superior functional recovery and patient satisfaction 1, 2.
Soft or elasticated bandages represent an even less restrictive alternative that has shown comparable outcomes to casting, with more children achieving no or limited disability at four weeks 2.
The traditional approach of rigid below-elbow casting is no longer necessary for stable, minimally displaced fractures given the robust remodeling potential in the pediatric population 3, 2.
Duration and Follow-Up
Immobilization should continue for approximately 3 weeks with radiographic follow-up at this time point and again at immobilization removal to confirm adequate healing 1.
Most pediatric distal radius fractures heal within 6 weeks, though stable buckle fractures typically require less time 4.
Active Motion Protocol
Initiate active finger motion exercises immediately following diagnosis to prevent stiffness, which is the most functionally disabling complication of distal radius fractures 1.
Finger motion does not adversely affect adequately stabilized distal radius fractures and should be encouraged throughout the immobilization period 1.
Early wrist motion is not routinely necessary following stable fracture immobilization 1.
When Removable Splinting Is NOT Appropriate
Displacement Thresholds Requiring Rigid Immobilization or Surgery
Any displacement >3mm, dorsal tilt >10°, or intra-articular involvement requires consideration of rigid casting or surgical intervention rather than removable splinting 1, 5.
For displaced fractures requiring closed reduction, rigid immobilization with casting is preferred over removable splints to maintain reduction 1.
Complete displacement, particularly in children over 9 years of age, may require percutaneous pinning after closed reduction to prevent treatment failure 2, 4.
Age-Specific Remodeling Considerations
Children under 9 years can tolerate up to 15° of angulation and 45° of malrotation due to superior remodeling capacity 4.
Children 9 years or older have more limited remodeling potential, accepting only 10° angulation for proximal fractures and 15° for distal fractures, with 30° malrotation 4.
Practical Implementation
Cost and Convenience Advantages
Removable splints demonstrate lower healthcare costs compared to traditional casting, eliminating the need for cast room visits and specialized removal 2.
Home removal of immobilization devices by parents is safe and effective, showing equivalent outcomes to hospital-based removal with greater parental satisfaction and reduced healthcare costs 1, 2.
Common Pitfalls to Avoid
Do not manipulate physeal fractures presenting more than 10 days post-injury due to increased risk of physeal arrest 3.
Monitor for immobilization-related complications (skin irritation, muscle atrophy) which occur in approximately 14.7% of cases, though these are typically minor 1, 5.
Ensure proper diagnosis—buckle fractures are stable compression injuries distinct from greenstick or completely displaced fractures that may require different management 3, 2.
Expected Outcomes
Full restoration of physical function is expected at 4 weeks for appropriately treated minimally displaced fractures 2.
Refracture rates are negligible when proper immobilization is maintained for the recommended duration 2.
Physiotherapy is rarely required when removable splinting is used, with faster functional recovery compared to rigid casting 6, 7.