Interventions for treating wrist fractures in children

Area of Science:

• Orthopedic Surgery
• Pediatric Traumatology
• Evidence-Based Medicine

Background:

• Wrist fractures are common in children, accounting for approximately one-third of all pediatric fractures.
• These injuries often result from falls onto an outstretched hand.

Purpose of the Study:

• To evaluate removable splintage versus plaster casts for undisplaced buckle fractures in children.
• To assess cast length and position for pediatric wrist fractures.
• To determine the role of surgical fixation for displaced wrist fractures in children.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searched multiple databases including Cochrane, MEDLINE, EMBASE, and CINAHL up to October 2007.
• Included 10 trials involving 827 children, assessing variable quality.

Main Results:

• Removable splintage showed no short-term deformity and was preferred by children and parents for buckle fractures.
• Below-elbow casts were less restrictive and did not increase redisplacement or complications compared to above-elbow casts.
• Percutaneous wiring reduced redisplacement but functional outcomes at three months were not improved.

Conclusions:

• Limited evidence supports removable splintage for buckle fractures, challenging traditional above-elbow casting for displaced fractures.
• Percutaneous wire fixation prevents redisplacement, but long-term functional outcomes require further investigation.
• Further research is needed on optimal splintage for buckle fractures and indications for surgery in displaced wrist fractures.