Treatment of Buckle Fractures
Buckle fractures should be treated with a removable splint worn for 3 weeks without routine follow-up or repeat radiographs. 1
Immobilization Method
Use a removable wrist splint rather than a circumferential cast. Multiple randomized controlled trials demonstrate that removable splints provide:
- Superior physical functioning at 14 days post-injury compared to casting 2
- Higher patient and parent satisfaction, convenience, and preference on all measures 3
- No difference in pain scores between splint and cast groups 3, 2
- Zero risk of fracture displacement with splint treatment, as buckle fractures are inherently stable 1, 3, 2, 4
The evidence consistently shows splinting is preferable across all outcome measures except initial emergency department pain, which showed no clinically significant difference 3.
Duration of Immobilization
- Immobilize for exactly 3 weeks 1, 2, 4
- This duration applies regardless of whether splint or cast is used 2, 4
Follow-Up Protocol
No routine clinical or radiological follow-up is necessary after initial diagnosis. 1, 4
- Provide adequate patient/parent education at time of diagnosis 1
- Review patient the following day only to confirm diagnosis and provide advice 4
- No evidence supports additional clinic visits or repeat radiographs 1, 4
Critical Pitfalls to Avoid
- Do not use circumferential casts - they increase skin complications (3.1% complication rate), require more clinic visits, and provide no clinical benefit over splints 5
- Do not order routine follow-up radiographs - buckle fractures have zero displacement risk and imaging adds no value 1, 4
- Do not schedule multiple clinic visits - this wastes healthcare resources without improving outcomes 1, 4
Special Considerations
For proximal tibial buckle fractures specifically, a removable knee immobilizer is superior to long leg casting, with shorter immobilization duration (25.9 vs 27.9 days) and fewer clinic visits (2.2 vs 2.6 visits) 5.