What is the appropriate management for an isolated distal radius buckle (torus) fracture in a healthy child (5‑12 years) with no neurovascular compromise?

Management of Distal Radius Buckle Fractures in Children

For an isolated distal radius buckle (torus) fracture in a healthy child aged 5-12 years without neurovascular compromise, treat with a removable wrist splint for 3 weeks, provide discharge instructions in the emergency department, and do not schedule routine follow-up appointments or repeat radiographs. 1

Immobilization Method and Duration

• Use a removable wrist splint (such as a Futura-type splint) rather than a traditional circumferential plaster cast for buckle fractures, as these injuries are inherently stable compression fractures of the metaphyseal cortical and cancellous bone 1, 2
• Immobilize for exactly 3 weeks, which provides adequate healing time without unnecessary prolongation of treatment 1, 2
• The removable splint has equivalent outcomes to traditional casting but offers superior patient comfort, hygiene, and cost-effectiveness 2

Follow-Up Strategy

• No routine clinical follow-up appointments are necessary once adequate information is provided at the time of diagnosis 1
• No repeat radiographs are required to confirm healing, as buckle fractures heal reliably without displacement 1
• If follow-up is desired by families, primary care physician reassessment is appropriate rather than orthopedic specialty consultation, with 87.2% of families successfully managing with PCP follow-up exclusively 3

Patient/Parent Education at Discharge

• Provide clear written and verbal instructions about splint wear, expected healing timeline, and return to activities 1
• Advise parents that the child can return to usual activities after the 3-week immobilization period 3
• Initiate active finger motion exercises immediately to prevent finger stiffness, which does not adversely affect these stable fractures 4, 5
• Instruct families on warning signs that would warrant return to care: increasing pain, numbness, tingling, or inability to move fingers 1

Critical Pitfalls to Avoid

• Do not confuse buckle fractures with other distal radius fracture patterns that require different management—buckle fractures are stable compression injuries without cortical breach on the opposite side, unlike complete fractures or greenstick fractures 1
• For children ≥7 years old, if the fracture-to-physis distance is <1 cm on radiographs, reconsider the diagnosis as it is unlikely to be a simple buckle fracture and may represent a potentially unstable fracture pattern requiring closer follow-up 6
• Avoid using removable splints for comminuted or displaced fractures—these require rigid cast immobilization or surgical management 7
• Do not schedule unnecessary orthopedic referrals, as only 3.9% of buckle fractures managed by PCPs required specialty consultation 3

Resource and Cost Considerations

This simplified management approach represents significant savings in healthcare resources by eliminating unnecessary clinic visits, repeat radiographs, and specialist consultations while maintaining excellent clinical outcomes with nearly 99% of children returning to usual activities within 4 weeks 1, 3