Of note, on the posteroanterior view, the green arrows show the fracture across the distal radius and a subtle buckle fracture of distal ulna.
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Case 2: Simple buckle fracture of distal radius, stable.
Patient 2: 10-year-old male
Red arrow identifies the 1st metacarpal (thumb, volar side). Blue arrow shows the subtle buckle.
The fracture line does not extend to the volar cortex; there is no angulation.
This is a simple dorsal buckle fracture of the distal radius, stable, and well-managed in a removable splint for comfort and protection.
Case 4: Volar-based fracture of the distal radius with mild angulation that requires molding in extension and close follow-up.
Patient 4: 6-year-old female
Red arrow identifies the 1st metacarpal (thumb, volar side)—a little confusing because it overlaps with the 5th metacarpal. Blue arrow shows the buckle, but it is on the volar side.
The solid black line is along the axis of the proximal fragment of the radius and extended beyond the fracture, the dashed black line is along the axis of the distal fragment, and the lines are not parallel. There is mild angulation of the distal fragment volarly.
This case is also subtle, and if we don’t recognize the thumb/volar side, this will be incorrectly molded in flexion, which will increase the angulation, not help to correct it. So again, this is not a simple buckle fracture of the distal radius. However, this is unstable with a tendency to shift volarly and needs to be molded in extension.
Of note, on the posteroanterior view, the green arrow also shows the fracture of the distal radius.
References
- Koelink E, Schuh S, Howard A, et al. Primary care physician follow-up of distal radius buckle fractures. Pediatrics. 2016:137(1):e20152262.
- Abraham A, Handoll HH, Khan T. Interventions for treating wrist fractures in children. Cochrane Syst Rev. 2008;(2):CD004576.
- Davidson JS, Brown DJ, Barnes SN, et al. Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br. 2001;83(8):1173-1175.
- West S, Andrews J, Bebbington A, et al. Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. J Pediatr Orthop. 2005;25(3):322-325.
- Khan KS, Grufferty A, Gallagher O, et al. A randomized trial of ‘soft cast’ for distal radius buckle fractures in children. Acta Orthop Belg. 2007;73(5):594-597.
- Plint AC, Perry JJ, Correll R, et al. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117(3):691-697.
- Williams KG, Smith G, Luhmann SJ, et al. A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care. 2013;29(5):555-559.
- Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2013;44(4):508-513.
- Karimi Mobarakeh M, Nemati A, Noktesanj R, et al. Application of removable wrist splint in the management of distal forearm torus fractures. Trauma Mon. 2013;17(4):370-372.
- Koelink E, Boutis K. Paediatrician office follow-up of common minor fractures. Paediatr Child Health. 2014;19(8):407-412.
4 Responses to “Emergency Medicine Pearls, Pitfalls for Treatment of Pediatric Distal Radius Fractures”
November 19, 2017
Matt JaegerThanks so much! I appreciate your article very much. I often treat simple buckle fractures with a removable splint, but after reading your article I wonder if I may have done the same with a volar buckle fractures in the past. I will certainly change my practice. Thanks again.
July 30, 2018
Arun SayalThanks Matt.
There are tons of little pearls from our specialist colleagues – subtleties that help us manage us patients better.
Glad it helped.
Arun
November 19, 2017
AWHGreat article, and has absolutely changed my practice. Thank you Dr. Sayal!
July 30, 2018
Arun SayalThanks AWH!