It’s a wrap! Splints vs. casts

Removable splints preferred for forearm buckle fractures

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Among the most common pediatric injuries seen in emergency rooms are fractures that occur when children fall and try to catch themselves with an outstretched hand.

For many, that tumble on the playground, around the bases or off a bunk bed results in a buckle fracture, a forearm injury traditionally treated with a cast.

But new research from the School of Medicine shows that removable splints are clearly preferred by patients and their parents, building on earlier findings that such splints are just as effective as casts.

“Our goal is to manage these fractures in a manner that allows healing while maximizing comfort and convenience, yet minimizing disruptions in children’s active lifestyles,” says senior author Janet D. Luhmann, MD, an associate professor of pediatrics and physician in the emergency department at St. Louis Children’s Hospital.

“Traditionally, forearm buckle fractures have been managed with casts, which can be heavy, uncomfortable and, in the summer, hot and cumbersome. Without an expensive liner, children can’t get them wet, which results in significant inconvenience regarding swimming and hygiene.”

The new findings, coupled with earlier research into the effectiveness of splints versus casts, have led to a change in the standard treatment of these type of fractures at St. Louis Children’s. Now, prefabricated splints are the chosen treatment.

Further, absent pain experienced by patients, no longer is it recommended that they follow up with orthopedic surgeons and possibly undergo more X-rays. Rather, explains Kristine G. Williams, MD, the study’s lead author, children can be seen by their pediatricians two or three weeks later.

The researchers’ findings are available online in Pediatric Emergency Care.

A significant percentage of emergency department visits involve children seeking care for orthopedic injuries.

Children’s bones, when compared with the bones of adults, are less dense, more porous and more likely to bend than break. Buckle fractures are inherently stable and are at low risk for displacement and complete breakage, so they tend to heal well with minimal intervention.

Study findings, authors say, show that when treating uncomplicated buckle fractures near the wrist, splints are preferred by patients and their parents — in addition to being easier, less expensive and less time-consuming than casts.

‘’Parents rated the splint higher in almost all categories,” says Williams, an assistant professor of pediatrics who treats patients at St. Louis Children’s. “They tended to say they would definitely choose the splint again over a cast if they had a similar kind of injury.”

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