Soft cast versus rigid cast for treatment of distal radius buckle fractures in children

Buckle fractures are extremely common and their optimum management is still under debate. This study aimed to ascertain whether buckle fractures of the distal radius can be safely and effectively treated in soft cast with only a single orthopaedic outpatient clinic appointment.

A total of 232 children with buckle fractures of the distal radius were included in the study. 111 children with 112 distal radius fractures were treated in full rigid cast and 121 children with 123 fractures were treated with soft cast. The rigid cast children attended outpatient clinic for removal of cast at 3 weeks. Soft casts were removed by parents unwinding the cast at home after 3 weeks. Follow-up was conducted prospectively by telephone questionnaire at an average of 6 weeks post-injury.

Outcome data were available for 117 children treated in soft cast and for 102 children treated in rigid cast. The most common mechanism of injury was a fall sustained from standing or running, followed by falls from bikes and then trampoline accidents. Overall, both groups recovered well. Overall satisfaction with the outcome of treatment was 97.4% in soft cast and 95.2% in rigid cast. Casts were reported as comfortable by 95.7% in soft cast and 93.3% in rigid cast. Cast changes were required for 6.8% of soft casts and 11.5% of rigid casts. The most frequent cause for changing rigid casts was getting the cast wet. None of the improved scores seen in the soft cast group were statistically significant. No re-fractures were seen in either group. Nearly all (94.9%) children in soft cast did bathe, shower or swim in their cast. Parents of both groups preferred treatment with soft cast (p < 0.001). Reasons given for preferring the soft cast included the ability to get the cast wet, avoidance of the plaster saw and not having to take time off work to attend a follow-up visit for cast removal.

Buckle fractures of the distal radius can be safely and effectively treated in soft cast with only a single orthopaedic outpatient clinic appointment.