Journal of Pediatric Orthopaedics - 2026-07-01 - Journal Article; Randomized Controlled Trial
Buckle Up! Formal Restrictions Are Not Required After Pediatric Distal Radius Buckle Fractures.
Greenhill DA, Gomez R, Jain N, Valdes KG, Grimm N, Coffield K
Topics
Key Takeaway
Formal activity restrictions after pediatric distal radius buckle fractures increased QuickDASH scores (20.3 vs. 9.1) and parental worry without improving healing outcomes in any of 157 patients.
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Summary
This prospective semi-randomized study asked whether formally prescribed activity restrictions are necessary for isolated dorsal distal radius buckle fractures in children aged 5–16. Patients were allocated to splint with formal restrictions (n=57), splint without restrictions (n=68), or 3D-printed rigid cast without restrictions (n=32), with group assignment determined by a blinded call center. All patients healed without complications; restricted patients had significantly higher QuickDASH scores (20.3 vs. 9.1, p<0.001), greater activity reduction, and more parental anxiety, while the 3D-printed cast conferred no benefit over standard splint in the unrestricted cohort.
Key Limitation
Four-week follow-up is insufficient to detect late displacement or reinjury in competitive athletes, who comprised 61% of the cohort and self-restricted sports participation more than non-athletes.
Original Abstract
BACKGROUND
Trials that support brace treatment of pediatric distal radius buckle fractures either explicitly restricted all childhood activities or did not clarify activity protocols. In practice, parents and schools request documented recommendations. This prospective semi-randomized study aimed to determine whether formally prescribed activity restrictions are necessary during treatment of an isolated distal radius buckle fracture in school-aged children.
METHODS
Children 5 to 16 years old with an acute, dorsal, distal radius buckle fracture were prospectively enrolled into 3 cohorts: (group A) standard splint+formally prescribed activity restrictions, (group B1) standard splint without formal restrictions (self-limited activity), or (group B2) removable 3D-printed rigid cast without formal restrictions. The group A versus group B physician designation was determined by a blinded outpatient call center. Self-limited patients could alternatively elect a 3D-printed cast. Patients with volar/bicortical involvement were excluded. Self-limited patients returned at 4 weeks for clinical and radiographic follow-up. Patient-reported outcome measures (activity/satisfaction questions, scored 0 to 5, and QuickDASH scores) were obtained 4 weeks postinjury.
RESULTS
Among the 157 included patients, averaging 9.6±2.7 years old (57 in group A, 68 in group B1, and 32 in group B2), there were no demographic differences between the cohorts. Restricted patients significantly decreased their activity levels during treatment (4.6 to 3.4, P <0.001) while the self-limited patients did not (splint: 4.4 vs. 4.1, P =0.252; 3D-cast: 4.6 vs. 4.4, P =0.071). Competitive athletes (95/157 patients; 61%) reported restricting their sports participation more than those who did not play organized sports (2.3 vs. 1.5, P <0.001). Parents of restricted patients worried more often about the fracture (2.4 vs. 1.7, P <0.001). Restricted patients reported more limitations on the QuickDASH (20.3 vs. 9.1, P <0.001) and QuickDASH sports/performing arts (39.6 vs. 16.2, P =0.003) subscales. All patients demonstrated clinical and radiographic healing. There were no complications.
CONCLUSION
Pediatric patients with a dorsal distal radius buckle fracture may be allowed to self-limit activities while healing. Parents of self-limited patients worry less while their children routinely heal without complications. Among less-restricted patients, rigid 3D-printed casts did not provide additional benefits.
LEVEL OF EVIDENCE
Level II.