Splinting Pediatric Wrist Fractures as Effective as Casting

Splinting children’s distal radius fractures was found as effective as casting them in a randomized controlled study of 92 children, aged 5 to 12 years, who had transverse or greenstick fractures with minimal angulation

The Canadian investigators who treated 43 children with splints and 49 children with casts and assessed results 6 weeks later wrote in their study, which was published in the Canadian Medical Association Journal (CMAJ), “Our results support the growing body of evidence that promote splinting as a suitable alternative to casting for specific distal radius fractures.”

For the study, conducted by Kathy Boutis, MD, FRCPC, a staff physician and associate scientist at Toronto’s Hospital for Sick Children, and colleagues, the splint group was allowed to freely remove the splint in the first 4 weeks to wash, but otherwise they kept it in on for the duration of treatment, as did the cast group for the entire time, according to a CMAJ press release.

In all cases, initial fracture angulation was 15· or less.

“There were no differences in maintaining fracture stability, complications, and the splint was shown to be superior in terms of family preferences,” Boutis and colleagues wrote in the study.

After 6 weeks, a physiotherapist blinded to which treatment each child received assessed the outcomes and found the mean Activities Scores were 92.8 points in the splint group and 91.4 points in the cast group. After 4 weeks, the difference between the groups’ fracture angulation was not different, according to data contained in the study abstract.

“Inherent benefits of a pre-fabricated splint include easier hygiene, eliminating discomfort and anxiety associated with cast saw use, and easy application and removal. Thus, evidence from this research combined with the advantages of the splint advocate for this device in the treatment of these fracture cases,” the investigators wrote.

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