Better function with splinting for certain pediatric wrist fractures

Three weeks of constant wrist immobilization may be unnecessary for many children with buckle fractures.

Treating children’s distal radius or ulna fractures using removable splints is as effective as short arm casting, but allows better physical function without increased pain, according to a study by Canadian researchers.

Amy C. Plint, MD, and colleagues at the University of Ottawa and at Children’s Hospital of Eastern Ontario Research Institute conducted the prospective study with 113 children aged six to 15 years who had a buckle fracture of their distal radius or ulna. They defined a buckle fracture as compression of the bony cortex with an intact opposite cortex confirmed by a pediatric radiologist, according to the study.

Children were randomly assigned to receive either a below-elbow plaster cast or an individually fitted plaster splint. The researchers instructed splinted children to use the splint for comfort only and, when desired, to remove it and discontinue use. Casted children received the usual cast care instructions, and all children were told to avoid contact sports.

For data collection, the researchers gave all parents study materials to complete at home, which included an Activities Scales for Kids performance version (ASKp) questionnaire modified to include eight additional questions specifically relating to upper extremity function. Research assistants contacted parents weekly by telephone to collect the information. All children were also asked to return to the orthopedic clinic for follow-up assessments at 21 days.

The final data analysis included 87 of the 113 children initially randomized — 42 children in the splint group and 45 children in the cast group. Both groups were similar in age, gender, mechanism of injury, dominant hand injured, bone fractured, and baseline ASKp and Visual Analog Scale (VAS) pain scores, according to the study.

The researchers found that splinted children wore their splint for at least some part of the day/night for an average of 13.7 days, but with rapidly declining continuous use. “Interestingly, even by day seven postinjury, only 15% report wearing them all day and night. It seems that for many children with wrist buckle fractures, three weeks of constant immobilization is not necessary,” the study authors said.

At 14 days postinjury, splinted children had a significantly higher mean ASKp score compared to casted children (P=.041). However, there was no significant difference in ASKp scores between the groups at seven days, 20 days or 28 days postinjury, the authors said in the study. Both groups also had similar VAS-measured pain levels at all follow-up points, they noted.

Regarding function, splinted children had significantly better ASKp-measured functional improvements at 14 and 20 days postinjury. It was also significantly easier for these children to bath at seven, 14 and 20 days (P<.001). At 20 days, splinted children could also perform other daily activities significantly better, including printing or writing (P=.005), drawing (P=.005) and grooming (P=.023). However, “these differences do not remain significant after Bonferroni adjustment for multiple testing,” the authors noted.

Regarding physical activity and sports, more splinted children returned to preinjury levels. At 20 days postinjury, 18 of 25 splinted children and 13 of 32 casted children (P=.031) returned to preinjury activity levels. At 28 days, 25 of 26 splinted children and 23 of 34 casted children (P=.008) returned to such activities, according to the study.

“Our study ... has shown that splinted children have better physical functioning, less difficulty with many activities, are able to return to sports sooner, and suffer no significantly greater pain,” the authors said.

For more information:
Plint AC, Perry JJ, Correll R, et al. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117:691-697.