O ur aim was to determine whether children with buckle fractures of the distal radius could be managed at home after initial hospital treatment. There were 87 patients in the trial: 40 had their short-arm backslab removed at home three weeks after the initial injury, and 47 followed normal practice by attending the fracture clinic after three weeks for removal of the backslab.Clinical examination six weeks after the injury showed no significant difference in deformity of the wrist, tenderness, range of movement and satisfaction between the two groups. Fourteen (33%) of the hospital group compared with five (14%) (p = 0.04) of those managed in the community stated that they had problems with the care of their child's fracture. It was found that both groups, given a choice, would prefer to remove their child's backslab at home (p < 0.001). Our findings show that it is clinically safe to manage children with buckle fractures within the community. The inherent stability of many fractures of the distal radius has encouraged the use of various methods of management. A recent report 1 audited the treatment of greenstick fractures of the distal radius using a soft cast which was removed by patients at home. This showed effective reduction in the numbers attending the clinic and that the patients involved were satisfied with the treatment. However, without formal follow-up, the clinical effectiveness of such treatment remains in doubt. Our study aimed to show that home management of buckle fractures of the distal radius is clinically safe and satisfactory. Patients and MethodsThe study was approved by the local Ethics Committee. Between September 1997 and May 1998, 154 children were diagnosed as having buckle fractures of the distal radius on presentation to the Accident and Emergency Department of Leicester Royal Infirmary. Of these, 101 were referred to the study team. We excluded patients who had pathological fractures, previous problems with the wrist on the side of the fracture, bicortical fractures and those who did not understand or were unwilling to enter the study. Patients and their parents were seen on the day of presentation. Three were diagnosed as having bicortical fractures, one had had previous abnormality of the wrist on the side of the fracture, four attended without their parents, one spoke no English, two wished to be followed up in another city and in three the parents refused consent. This left 87 patients for whom parental consent for entry into the trial was obtained. These were subsequently randomised either to home (study) or hospital (control) groups using a computer-generated random-number sheet. In each group the fracture was treated in a below-elbow backslab. Patients in the hospital group followed our usual management for buckle fractures of the distal radius; they returned to the fracture clinic three weeks after injury for removal of the backslab by nursing staff and for medical review.Those randomised to the home group did not return to the hospital, but had their backslab removed by the...

A wide variation exists in the appearance and duration of the radiographic signs of bone healing. Marginal sclerosis should be an expected radiographic sign of normal bone healing. Applying maximum and minimum time spans to objective radiographic signs may aid in fracture dating.

Our aim was to determine whether children with buckle fractures of the distal radius could be managed at home after initial hospital treatment. There were 87 patients in the trial: 40 had their short-arm backslab removed at home three weeks after the initial injury, and 47 followed normal practice by attending the fracture clinic after three weeks for removal of the backslab. Clinical examination six weeks after the injury showed no significant difference in deformity of the wrist, tenderness, range of movement and satisfaction between the two groups. Fourteen (33%) of the hospital group compared with five (14%) (p = 0.04) of those managed in the community stated that they had problems with the care of their child's fracture. It was found that both groups, given a choice, would prefer to remove their child's backslab at home (p < 0.001). Our findings show that it is clinically safe to manage children with buckle fractures within the community.