Evidence-Based Management of Pediatric Distal Radius Buckle Fractures

Distal radius fractures are the most common fracture in children younger than 16 years. A common pattern of distal radius fractures is the buckle or torus fracture. Traditional treatment of these injuries involved casting with serial x-ray imaging to evaluate for proper healing and maintained alignment. Studies of these injury patterns, however, suggest that these fractures are inherently stable and have a very low incidence of displacement. These studies posit that torus fractures can be treated definitively in a removable brace that can be discontinued by the patient's caregiver without the need for follow-up examinations or imaging. A review of pertinent literature from the past 5 years concluded that, in pediatric patients with acute radial torus fractures, clinical outcomes were equivalent between patients treated with removable braces and no scheduled follow-up and those treated with hard casting and repeat clinical evaluation. Implementation of this evidence-based treatment can significantly improve patient care by reducing unneeded follow-ups and imaging while minimizing the cost of treatment and missed school/work days by patients and their caregivers.