Pediatric buckle fractures: Cochrane findings support shift from casting

  • Handoll HH & al.
  • Cochrane Database Syst Rev
  • 19 Dec 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For pediatric buckle fractures of the wrist, full recovery is the norm, regardless of treatment used.
  • This Cochrane review of randomized controlled trials (RCTs) finds no specific support for a given treatment but support for a move away from cast immobilization for buckle fractures.

Why this matters

  • These distal radius fractures are the most common among children, and most of them are buckle fractures.
  • Controversy continues over whether these fractures require immobilization.
  • FORCE 2018 trial is ongoing .

Key results

  • High risk for bias among all studies (little blinding).
  • Removable splint vs cast did not produce different outcomes for device change, performance, refractures, pain.
  • Splints might be more inexpensive.
  • Soft bandage vs cast also yielded similar outcomes.

Study design

  • 30 studies (21 RCTs) included (n=2930).
  • Funding: University of Manchester, UK; Teesside University, Middlesbrough, UK, other.

Limitations

  • Those of included studies, including high bias risk.

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