Buckle Up! Formal Restrictions Are Not Required After Pediatric Distal Radius Buckle Fractures

Trials that support brace treatment of pediatric distal radius buckle fractures either explicitly restricted all childhood activities or did not clarify activity protocols. In practice, parents and schools request documented recommendations. This prospective semi-randomized study aimed to determine whether formally prescribed activity restrictions are necessary during treatment of an isolated distal radius buckle fracture in school-aged children.

Children 5 to 16 years old with an acute, dorsal, distal radius buckle fracture were prospectively enrolled into 3 cohorts: (group A) standard splint+formally prescribed activity restrictions, (group B1) standard splint without formal restrictions (self-limited activity), or (group B2) removable 3D-printed rigid cast without formal restrictions. The group A versus group B physician designation was determined by a blinded outpatient call center. Self-limited patients could alternatively elect a 3D-printed cast. Patients with volar/bicortical involvement were excluded. Self-limited patients returned at 4 weeks for clinical and radiographic follow-up. Patient-reported outcome measures (activity/satisfaction questions, scored 0 to 5, and QuickDASH scores) were obtained 4 weeks postinjury.

Among the 157 included patients, averaging 9.6±2.7 years old (57 in group A, 68 in group B1, and 32 in group B2), there were no demographic differences between the cohorts. Restricted patients significantly decreased their activity levels during treatment (4.6 to 3.4, P <0.001) while the self-limited patients did not (splint: 4.4 vs. 4.1, P =0.252; 3D-cast: 4.6 vs. 4.4, P =0.071). Competitive athletes (95/157 patients; 61%) reported restricting their sports participation more than those who did not play organized sports (2.3 vs. 1.5, P <0.001). Parents of restricted patients worried more often about the fracture (2.4 vs. 1.7, P <0.001). Restricted patients reported more limitations on the QuickDASH (20.3 vs. 9.1, P <0.001) and QuickDASH sports/performing arts (39.6 vs. 16.2, P =0.003) subscales. All patients demonstrated clinical and radiographic healing. There were no complications.

Pediatric patients with a dorsal distal radius buckle fracture may be allowed to self-limit activities while healing. Parents of self-limited patients worry less while their children routinely heal without complications. Among less-restricted patients, rigid 3D-printed casts did not provide additional benefits.

Level II.