Patient and parent satisfaction with soft cast immobilization and a single visit for buckle fractures

Compression fractures of the distal radius (known as buckle or torus fractures) should be managed with non-rigid immobilization and a single visit as per the NICE guidelines. A recent national survey demonstrated ongoing reluctance to incorporate this treatment strategy in Ireland, with more than 70% of institutions still managing these fractures with the traditional method (rigid cast immobilization and fracture clinic follow up). In this study we assessed whether this could be attributed to parent or carer preference.

All paediatric patients from January 2021 to August 2022 in a single centre with buckle fractures of the distal radius were included in this study. A 10-question survey was created to assess whether the care giver and patient was satisfied with the information supplied, method of stabilization, single point of contact, and self-removal of the soft cast. A maximum of 5 points could be given to each score with a maximum of 50 for the overall satisfaction of care.

A total of 82 surveys were completed via the post or telephonically. The two lowest average scores were 3.77 (SD ± 1.20) and 3.95 (SD ± 1.24), which indicated that patients would have no issues organising a follow up appointment and difficulty with cast removal respectively. Three other questions scored slightly better with 4.12 (SD ± 1.02), 4.17 (SD ± 1.04) and 4.22 (SD ± 1.05) which demonstrated some dissatisfaction with the cast condition at time of removal, difficulty with returning to school directly after removal and a desire to have another follow up appointment respectively. The highest average score was for adequacy of information provided at the time of treatment, 4.58 (SD ± 0.67). Furthermore, high scores were also given to the questions regarding confidence in the stability provided by the soft cast and the modality of treatment provided.

This study highlighted that one of the limiting factors to implementing the non-rigid immobilization and single visit protocol for buckle fractures as recommended by NICE is likely due to parental wariness and frequent dissatisfaction. This was mostly attributed to soft cast immobilization as patients experienced similar complications as found with rigid immobilization. The authors would rather suggest splint or soft bandage immobilization as this would likely improve patient/parent satisfaction with single visit treatment. With regards to further research, a follow up study can be performed focussing on the physician's preferences with regards to buckle fracture treatment protocol. And to determine what factors from the physician's perspective contributes to the reluctance in implementing the NICE guidelines protocol.