From the Guidelines
Buckle fractures of the distal radius and ulna are best managed with immobilization and pain management, as they are stable compression fractures that typically heal well without complications, especially in children with excellent remodeling potential 1.
Treatment Approach
The treatment approach for buckle fractures of the distal radius and ulna involves immobilization with a removable splint or cast for 3-4 weeks, which provides adequate support while allowing for better hygiene and comfort compared to traditional casts.
- Immobilization period: 3-4 weeks
- Pain management: acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) as needed for the first few days
- Follow-up: 3-4 weeks to confirm healing, with additional imaging only if symptoms persist
Return to Activities
Most patients can return to normal activities after the immobilization period, though contact sports should be avoided for an additional 2-3 weeks.
- Return to normal activities: after immobilization period
- Avoid contact sports: for an additional 2-3 weeks
Complications and Recovery
These fractures generally heal well without complications due to children's excellent remodeling potential.
- Complete recovery: expected within 6-8 weeks without long-term functional limitations
- Potential complications: increasing pain, numbness, color changes in fingers, or if the splint becomes too tight or loose, which require immediate medical attention
Evidence-Based Recommendations
The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed an evidence-based Clinical Practice Guideline (CPG) for the treatment of distal radius fractures, which includes recommendations for immobilization, pain management, and follow-up care 1.
- Immobilization: recommended for 3-4 weeks
- Pain management: acetaminophen or ibuprofen as needed for the first few days
- Follow-up: recommended at 3-4 weeks to confirm healing, with additional imaging only if symptoms persist
From the Research
Buckle Fractures of Distal Radius and Ulna
- Buckle fractures, also known as torus fractures, are a type of fracture that occurs when there is an incomplete compression of the bone without cortical disruption 2.
- These fractures are common in children and can be managed with immobilization, depending on the degree of angulation 2.
- In adults, distal radius fractures are the most common forearm fractures and are typically caused by a fall onto an outstretched hand 2.
Management of Buckle Fractures
- Traditional approaches to managing buckle fractures involved immobilization in a circumferential cast, but current evidence supports the use of removable splints with or without radiological and clinical follow-up 3.
- A systematic review found that torus fractures can be managed with a removable splint supplied in the emergency department and worn for 3 weeks, with no need for fracture clinic follow-up or repeat radiological imaging 3.
- A survey of pediatric orthopaedic specialists found that the majority prefer to use removable wrist splints for buckle fractures, with minimal follow-up and no reimaging 4.
Diagnosis and Treatment
- A measurement rule, known as the 1-cm rule, can be used to aid in differentiating stable buckle fractures from other distal radius fractures in children 5.
- The rule states that an isolated distal radius fracture in a child 7 years or older is not likely to be a buckle fracture if the fracture-to-physis distance is <1 cm 5.
- A study found that removable brace and home management treatment is safe for volar distal radius buckle fractures, with a low rate of complications and no significant differences in treatment outcomes compared to dorsal buckle fractures 6.
Key Findings
- Buckle fractures are common in children and can be managed with immobilization and removable splints 2, 3, 4.
- The 1-cm rule can be used to aid in diagnosis and treatment of buckle fractures in children 5.
- Removable brace and home management treatment is safe for volar distal radius buckle fractures 6.