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Splint or cast for buckle fractures of the wrist

Three Part Question

In [paediatric buckle wrist fractures] is [a futura splint or other removable supportive device as good as plaster cast immobilisation] for [functional recovery without increasing complications?]

Clinical Scenario

You wonder why some hospitals splint buckle fractures and others plaster them. Is there any need to plaster these fractures?
Only 1 study for futura splints (currently a 2nd trial in recruitment stage in Washinton USA).
So looked for papers that compared plaster cast with alternatives including wool and crepe and tubigrip, 1 trial comparing splint with no treatment at all.

Search Strategy

exp Radius Fractures/ or or or exp Ulna Fractures/ or exp Ulna/ or or or exp Wrist/ or exp Radius/ or or exp Forearm/ or or or metaphyseal or Greenstick AND ( or exp Splints/ or or or exp Fracture Fixation/ or exp Immobilization/ or or or exp Braces/
Limit to (english language and humans and "all child (0 to 18 years)") 1394
Medline, Cinahl, Embase
Cochrane database
google scholar
unpublished trial from clinical trials registry

Search Outcome

25 papers
11 papers directly relevant to question.
5 were reviews.
6 papers of which 1 is unpublished.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Kropman R.H.J., Bemelman M,
Feb 2010
92 children age 4-13 years with buckle fracture Compared wool and crepe (changed to tubigrip at 1 week) with plaster cast PRCTPain VASIncreased pain in bandage group compared to plaster at wk 1.Excluded patients -not intention to treat analysis -interpretation bias
Comfortitching 219 cast 140 bandage P<0.001
ROM wrist26 +/-19mm bandage 20+/-16mm plaster
RefractureNo refracture at 4 weeks
West et al,
Wool & Crepe v Plaster cast N=39 PRCTPainW&C 22% Cast 71%-Small sample size. -Not intention to treat. -Treatment bias -Assessment bias
ROM at 4 weeksW&C 162o Cast 126o
Plint et al,
Plaster Splint v Backslab N=113 randomised 87 analysed PRCTASKp (activity scale for Kids- Daily physical function)Significant difference in ASKp scores at day 14 for splint. No diff at day 7 or 20. Study Strengths -Prospective -longer term follow up (6 months) Significant no.s not included or lost to follow up
RefractureNo refracture at 6 months
Plint et al,
309 buckle fractures. 13% (40) had been in a plaster splint Retrospective cohort 2000-2001Fracture displacementAll 40 splinted had no fracture displacementWeaknesses -retrospective -Assumption that those lost to F/U were unlikely to have had complications
Complications32 unplanned ED visits with cast related problems (30 for cast and 2 for splint)
Ziouani and Jacobs
UK (unpublished)
Children <17yr Torus fracture distal wrist randomized after Xray diagnosis into 2 groups Splint v no treatment RCTDifference in pain levels at weeks1 and 4. Time to return to normal use of affected limb with & without splint No differencePilot Lost data
van Bosse et al,
buckle # 1-13yr Removable plaster splint N=48 Retrospective review 2001-2004 1o outcome: angulation onInitial and F/U Xrays.Statistical diff between initial & F/U lateral Xray -1.7o (p=0.03) “not clinically significant”Bias -no control group - Small no.s with large loss to F/U.
Complications2 had slight pain despite 3 weeks of splintage but had resumed all normal activities.
Davidson JS,
Cost-benefit analysis N=201 PRCTComplicationsNo difference in clinical and radiological outcome for splints or casts.

Saving per patient £51.23 if futura splint used rather than cast
No clear outcome measure -Quasi-randomized. -No sample size estimates. -no outcome measure -Loss to F/U -No statistical analysis of data


No good trials but all trials have no refracture complications. No evidence to suggest that futura splint is inferior to plaster cast immobilisation it is superior in terms of patient satisfaction. Wool and crepe/bandage/ no treatment no evidence.

Clinical Bottom Line

Safe to treat buckle fracture in a futura splint so long as there is a system in place to prevent misdiagnosis of other fractures.


  1. Kropman R.H.J., Bemelman M, Treatment of Impacted Greenstick Fractures in Children using Bandage or Cast Therapy: A Prospective Randomised Trial. J.Trauma 2010;68:425-428 425-428.
  2. West S, Andrews J, Bebbington A, Ennis O, Alderman P. Buckle Fractures of the Distal Radius Are Safely Treated in a Soft Bandage. J Paediatric Orthop 2005;25:322-325
  3. Plint AC, Perry J.P, Correll R, Gaboury I, Lawton L. A Randomised, Controlled Trial of removable Splinting versus Casting for Wrist Buckle Fractures in Children. Paediatrics 2006;691-697.
  4. Plint, A.C, Perry J.P, Tsang J.LY. Paediatric Buckle fractures: Should we just splint and go? Can J Emerg Med 2004;6(6):397-401.
  5. Ziouani. Jacobs M. Unpublished pilot. Pilot Randomised Controlled Trial at Hertfordshire Hospitlas NHS Trust. Distal Forearm Fractures- do they need a splint? (accessed 24 June 2010) ISRCTN34857372
  6. van Bosse HJP, Patel RJ, Thacker M, Sala DA. Minimalistic Approach to Treating Wrist Torus Fractures. J Pediatric Orthop 2005;25:495-500.
  7. Davidson J.S. Simple treatment for torus fractures of the distal wrist. The Journal of Bone and Joint surgery (Br) 2001;Vol 83-B, issue 8, 1173-1175.