Recommended Splint Type for Distal Radius Buckle Fractures
A removable splint is the recommended treatment for distal radius buckle (torus) fractures, as it provides superior physical functioning compared to casting while maintaining adequate fracture stability. 1, 2
Treatment Approach
Primary Immobilization Method
- Use a removable splint applied in the emergency department or clinic for 3 weeks 1, 3
- Removable splints result in significantly better physical functioning at 14 days post-injury compared to short arm casts, with particular improvement in bathing and daily activities 2
- Buckle fractures are inherently stable compression injuries of cortical and cancellous bone that do not require rigid immobilization 3, 4
Key Advantages of Removable Splinting
- Better physical functioning scores (ASKp) at day 14 compared to casting 2
- Less difficulty with activities of daily living throughout the treatment period 2
- No difference in pain levels compared to casting 2
- Zero refractures reported in clinical trials comparing splints to casts 2
Duration and Follow-Up
Immobilization Period
- Wear the removable splint for 3 weeks 1, 3
- The splint should be easily removable to allow active finger range-of-motion exercises 1, 5
Radiographic Follow-Up
- Radiographic follow-up at approximately 3 weeks is recommended to confirm adequate healing 1
- However, current evidence suggests that buckle fractures do not displace further regardless of treatment, and follow-up radiographs may not be necessary once adequate information is provided at diagnosis 3, 4
- In a review of 106 pediatric buckle fractures, none displaced further during treatment 4
Essential Concurrent Management
Active Finger Motion Exercises
- Instruct patients to perform active finger motion exercises immediately following diagnosis 1, 6
- Finger stiffness is one of the most functionally disabling adverse effects of distal radius fractures 7, 1
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
- This intervention is extremely cost-effective and provides significant impact on patient outcome 7
Wrist Motion
- Early wrist motion is not routinely necessary following stable fracture fixation 1
- The removable nature of the splint allows for gentle wrist motion as tolerated, but this is not required for optimal healing 7
When Removable Splinting Is NOT Appropriate
Indications for Rigid Immobilization or Surgery
- Displacement >3mm 1, 6
- Dorsal tilt >10° 1, 6
- Intra-articular involvement 1
- For these displaced fractures, rigid immobilization (casting) or surgical management is preferred over removable splints 1
Monitoring for Complications
Expected Complication Rate
- Skin irritation and muscle atrophy occur in approximately 14.7% of immobilization cases 1, 6
- Monitor for these complications at follow-up visits 1
Adjunctive Treatment
- Consider vitamin C supplementation for prevention of disproportionate pain (moderate recommendation strength from AAOS) 1
Common Pitfalls to Avoid
- Do not use circumferential casts for true buckle fractures - they provide no additional stability benefit and worsen functional outcomes 2, 3
- Do not restrict finger motion - failure to emphasize active finger exercises leads to preventable stiffness 7, 1
- Do not schedule unnecessary follow-up visits - buckle fractures are stable and do not require routine fracture clinic follow-up if adequate initial education is provided 3, 4
- Ensure accurate diagnosis - confirm this is truly a buckle/torus fracture without significant displacement, angulation, or intra-articular extension before choosing conservative management 1