Interventions for treating wrist fractures in children

Area of Science:

• Pediatric Orthopedics
• Traumatology
• Evidence-Based Medicine

Background:

• Distal radius fractures are common in children, with buckle fractures being the most frequent and stable type.
• Significant variations exist in managing pediatric wrist fractures, including immobilization extent and surgical interventions for displaced fractures.

Purpose of the Study:

• To evaluate the benefits and harms of interventions for common distal radius fractures in skeletally immature children and adolescents.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases up to May 2018, including Cochrane, MEDLINE, and Embase.
• Assessed outcomes such as physical function, treatment failure, adverse events, recovery time, pain, and satisfaction, using GRADE for evidence quality.

Main Results:

• Thirty studies (2930 children) were included, all at high risk of bias, primarily due to lack of blinding.
• Low to very low-quality evidence was found for comparisons including removable splints vs. casts, bandages vs. casts, home vs. hospital cast removal, below-elbow vs. above-elbow casts, and surgical fixation vs. casting alone.
• Reassuring evidence suggests full functional recovery with no serious adverse events for buckle fractures, irrespective of treatment.

Conclusions:

• The quality of evidence for pediatric distal radius fracture interventions is generally low or very low.
• Buckle fractures demonstrate good outcomes and return to function regardless of treatment, supporting a move away from rigid cast immobilization.
• High-quality research is essential to resolve treatment uncertainties, with ongoing trials addressing key questions.