Wrist Fractures: to splint or cast?

Wrist fractures are the most common fx in children
– Traditionally they are treated with short arm cast for 4-6 weeks.
– Casts, however, make it difficult to bathe and are stinky and uncomfortable… and can be used as weapons against siblings (leading to more trauma patients!).
– Studies in adults have shown that prefabricated splints are an effective alternative to casting in selected populations.

– A recent study compared splints versus casts in kids 5-12 yrs who came to ED with minimally angulated (<15 degrees) greenstick or transverse fractures of the wrist.
– Patients were randomized to short arm cast or prefabricated splint for 4 weeks.
– Primary Outcomes = physical function at 6 weeks. Additional outcomes = degree of angulation, range of motion, grip strength, and complications.

– Results showed little difference between the two groups in daily activities that they could perform, ROM, grip strength, and pain scores.
– Mean fracture angulations did not differ significantly between the groups at 4 weeks.
– Kids and parents preferred the splint… likely because no one had a foul odor emanating from his or her arm.

– So, for that distal radius greenstick fracture, call your orthopod for appropriate follow-up, but tell them that they don’t need call the OrthoTech, you’ll just get a fashionable Velcro-wrist splint.
– And don’t forget analgesics!!

Boutis K, et al. Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial. CMAJ. 2010; 182:1507-1512

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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