Does degree of immobilization influence refracture rate in the forearm buckle fracture?

Kennedy, Stephen A.; Slobogean, Gerard P.; Mulpuri, Kishore

doi:10.1097/bpb.0b013e32832f067a

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…A 2010 meta-analysis in the Journal of Pediatric Orthopedics revealed that 455 patients placed in removable splints did not suffer from re-fractures and had higher satisfaction scores 14. Additionally, multiple small studies showed better functional outcomes with either removable splints or simple ACE wraps.…”

Section: Resultsmentioning

confidence: 99%

Blog and Podcast Watch: Orthopedic Emergencies

Grock

Rezaie²,

Swaminathan

et al. 2017

WestJEM

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IntroductionThe WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing ALiEM Approved Instructional Resources (AIR) and AIR-Professional series. Both series critically appraise resources using an objective scoring rubric. This installment of the Blog and Podcast Watch highlights the topic of orthopedic emergencies from the AIR series.MethodsThe AIR series is a continuously building curriculum that follows the Council of Emergency Medicine Residency Directors (CORD) annual testing schedule. For each module, relevant content is collected from the top 50 Social Media Index sites published within the previous 12 months, and scored by eight AIR board members using five equally weighted measurement outcomes: Best Evidence in Emergency Medicine (BEEM) score, accuracy, educational utility, evidence based, and references. Resources scoring ≥30 out of 35 available points receive an AIR label. Resources scoring 27–29 receive an honorable mention label, if the executive board agrees that the post is accurate and educationally valuable.ResultsA total of 87 blog posts and podcasts were evaluated. Key educational pearls from the three AIR posts and the 14 honorable mentions are summarized.ConclusionThe WestJEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. This series provides an expert-based, post-publication curation of educational social media content for EM clinicians with this installment focusing on orthopedic emergencies.

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Section: Resultsmentioning

confidence: 99%

Blog and Podcast Watch: Orthopedic Emergencies

Grock

Rezaie²,

Swaminathan

et al. 2017

WestJEM

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“…Patients treated with removable splints have better range of motion, score higher in terms of function, and have less diffi culty with bathing than patients treated with casts. 5 No differences were found in clinical outcomes of patients treated in removal splints versus casts; furthermore, families preferred the home splint removal. 4 A long arm splint (3 to 4 weeks) can be used for children less than 2 years of age.…”

Section: Treatmentmentioning

confidence: 97%

“…Several randomized trials have demonstrated that true distal radius buckle fractures can be effectively managed with removable splints for 3 weeks and do not require further evaluation and treatment. [3][4][5] Although many practices continue to treat these fractures in fi berglass casts, recent research has shown that splint application is superior to cast application. Patients treated with removable splints have better range of motion, score higher in terms of function, and have less diffi culty with bathing than patients treated with casts.…”

Section: Treatmentmentioning

confidence: 99%

Pediatric wrist injury after a fall

Rinaca

Stifler

Abzug

2014

Journal of the American Academy of Physician Assistants

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CASEAn 11-month-old girl was brought to the pediatric orthopedic clinic for further evaluation and treatment of left wrist pain following a fall 2 days earlier. The patient's mother stated that the child fell backward off a bed and landed on her outstretched hand. The patient was initially evaluated at an urgent care center and placed in a splint for a possible fracture. The remainder of her medical history was unremarkable.Physical examination The examination revealed a well-appearing female child in no apparent distress. No tenderness to palpation or bruising was present on either lower extremity or the right upper extremity. The skin on the left upper extremity was intact and no signifi cant swelling was noted. She was neurovascularly intact throughout the entire extremity. Signifi cant tenderness and discomfort were noted upon palpation about the dorsal aspect of the distal radius. No additional areas of tenderness were present throughout the remainder of the left upper extremity. Radiographs were obtained to further assess the left wrist for a potential fracture. What do Figures 1 and 2 demonstrate? DISCUSSIONThe images show the unicortical disruption of the dorsal distal radial metaphysis.Fractures about the wrist account for 25% of all pediatric fractures, with the distal radius being the most common site. 1,2 Fractures of the distal radius and forearm are the most common skeletal injuries in children that require surgical care. 3 Distal radius fractures are described according to their location, amount and direction of displacement, angulation, and rotation. Due to the increased porosity of pediatric bone, distal radius fractures typically involve the metaphysis or area about the physis. The distal radius fractures with metaphyseal involvement are classifi ed as torus (buckle) fractures, involving only one cortex, or bicortical fractures, which involve both cortices. 2 Torus fractures result from direct compression of the distal radial metaphysis and subsequently cause cortical failure, usually on the dorsal or radial side. 3 These injuries typically occur as a result of a fall onto an outstretched hand.Torus fractures are characteristically stable due to the unicortical involvement. However, this single cortex involvement makes them inherently less obvious on radiographic examination, sometimes causing the fracture to be missed by the clinician. Excellent bone remodeling occurs, due to the proximity of the fracture to the distal radial physis, which is responsible for the majority of the longitudinal growth of the radius bone. 4 Assessment For orthopedic patients presenting with pain, obtain a detailed patient history pertinent to the injury and FIGURE 1. Lateral view of left wrist showing unicortical disruption of the dorsal distal radial metaphysisFIGURE 2. Posteroanterior view of the left wrist showing unicortical disruption of the dorsal distal radial metaphysis (arrow)

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“…This finding was statistically insignificant. Overall, patients and caregivers prefer these devices because they permit handwashing and can be removed for bathing [ 28 ]. Regardless of the treatment modality selected, it is important to avoid contact sports and activities that can lead to reinjury for six to eight weeks [ 18 ].…”

Section: Reviewmentioning

confidence: 99%

“…The flexible treatment options such as bandages and removable splints may eliminate the need for an office visit for splint or cast removal [ 28 ]. These devices can be placed in the emergency department and removed conveniently at home two to three weeks post-injury [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

A Review of Pediatric Distal Radius Buckle Fractures and the Current Understanding of Angled Buckle Fractures

Gonzalez¹,

Lucas²,

Winegar³

et al. 2022

Cureus

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Distal radius buckle fractures (DRBFs) are the most common pediatric fractures and resemble the rounded portion of a Greek pillar or torus. They result from compressive forces applied to a child’s highly plastic radius. DRBFs lack cortical and physeal disruption, which makes them relatively stable. In this review, we discuss angled DRBFs, a hypothesized subset of buckle fractures that results from an off-center compressive force. Some authors refute the existence of angled DRBFs, instead proposing new criteria for DRBF classification: measuring more than 1 cm away from the physis with two to three inflection points. Without universal diagnostic criteria, misdiagnosis is common, and the utilization of flexible treatment modalities is infrequent. Rigid immobilization with short-arm casting continues to be the mainstay of treatment in clinical practice. Yet, new protocols implementing removable elastic bandages have had comparable results to casting, including reduced healthcare expenditure, less stiffness, and improved convenience and patient tolerability. Despite the discrepancies in categorizing DRBFs, complication rates remain low, and diagnostic confusion insignificantly affects clinical outcomes. Angled DRBFs have been theorized to have intraphyseal extension, making them unstable Salter-Harris fractures. Radiographic evidence supporting or denying this claim is limited. Further research is essential to determine the stability of the angled DRBF subtype and whether they should continue to be defined and managed as buckle fractures.

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Does degree of immobilization influence refracture rate in the forearm buckle fracture?

Cited by 15 publications

References 20 publications

Blog and Podcast Watch: Orthopedic Emergencies

Blog and Podcast Watch: Orthopedic Emergencies

Pediatric wrist injury after a fall

A Review of Pediatric Distal Radius Buckle Fractures and the Current Understanding of Angled Buckle Fractures

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