Reuters Health

Splints OK for minor wrist fractures in kids

April 25, 2008
By Anthony J. Brown, MD

NEW YORK (Reuters Health) - For treating minor fractures of the wrist in children, removable splints offer a more tolerable but equally effective alternative to the more usual plaster casts, researchers report.

They reviewed 10 randomized clinical trials involving 827 children and found that removable splints, either plastic or plaster, generally keep the fractures aligned as well as casts, but with greater comfort and less restriction, allowing children to bathe and participate in other activities.

The findings appear in The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

"There are minor, or buckle, fractures of the wrist, particularly in toddlers and preschool infants, that are currently being over-treated with a plaster cast and clinical follow-up," lead author Dr. Alwyn Abraham, an orthopedic surgeon with Leicester Royal Infirmary in the UK, said in a statement. "Provided these are accurately diagnosed in an emergency department, these minor fractures can be treated with a removable splint. Removal can be done at home with no further follow-up."

However, according to Dr. Leon Benson, spokesman for the American Academy of Orthopedic Surgeons, the ability to remove these splints, which makes them more comfortable and may help patients avoid a clinic visit, is also their biggest problem.

"Yes, you can treat a child's buckle fracture with a splint, but I don't," Benson said in a statement. "In my experience, a child under 10 is not going to keep a splint on, and who is going to take responsibility for that fact -- the doctor? And, given that fact, what parent wants to sit on pins and needles waiting for it to happen when a safe plaster cast insures it won't?"

SOURCE: The Cochrane Library, online April 16, 2008.

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