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Am Fam Physician. 2022;105(4):online

Author disclosure: No relevant financial relationships.

Data inadequate for analysis1 in 7 experienced a complication with a cast compared with a splint (number needed to harm = 7)
Higher risk of complication with a cast compared with a splint (absolute risk difference = 14%)

Details for This Review

Study Population: Children (two to 16 years of age) with confirmed forearm buckle fractures

Efficacy End Points: Functional recovery and patient satisfaction

Harm End Points: Complications, defined as refracture, cast heaviness, cast tightness, and cast-related return visits

Narrative: Wrist fractures involving the distal radius are the most common fractures in children.1 A buckle (i.e., torus) fracture in children usually occurs at the distal metaphysis where the bone is less dense. This injury is caused by buckling, or folding, of the cortex (the outer layer and thicker section of the bone) due to compression. Buckle fractures are stable, and treatment is intended to relieve pain and discomfort and protect the bone from further injury.2 There is debate about optimal fracture treatment using rigid casts or nonrigid methods (e.g., splints). The systematic review and meta-analysis summarized here compares the clinical effectiveness of nonrigid vs. rigid methods for forearm buckle fractures in children.3

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