The buckle or torus fracture is an extremely common injury in children. The current treatment regimen recommends some type of immobilization with either a cast or splint. The theme of this study was to show that buckle fractures in the radius may be safely treated in a soft bandage without adverse effects.
Patients were randomized into either a bandage or cast following a buckle fracture of the distal radius. The bandage consisted of a layer of orthopaedic wool covered with a layer of cotton crepe bandage, which was held with a tape. Immobilized patients were treated in a below-elbow cast with the fingers free. All patients were seen at one-week after initial evaluation. The bandage was changed at weekly intervals for four-weeks following trauma. Casting was also continued for a four-week duration.
There were 18 patients treated in a bandage and 21 in a cast. There were no adverse events or skin problems in either group. Parents were queried as to how comfortable their children were in the bandage or plaster cast. The bandage cohort was slightly more uncomfortable although the scale was not linear. Pain was similar in both groups. Ninety-five percent of patients treated in a bandage used and moved their wrist within the bandage during the first week. The majority of the patients treated in a bandage admitted to removal of the bandage during the first or second week. As expected, the return of motion was delayed in the cast group.
This study highlights that the buckle fracture of the distal radius is a stable injury with little or no chance of displacement. Treatment in a soft bandage appears to be appropriate in the properly selected child. However, children that are extremely active must be “protected” from themselves. Immobilization may still be necessary in certain children. The authors highlight that application of a soft bandage requires specific instructions similar to cast and immobilization.
J Pediatr Orthop