Published 7/1/2010
Terry Stanton

Splints as good as casts in some wrist fractures

In a study of children with distal radius and/or ulnar fractures, a prefabricated wrist splint was found to be as effective as a cast and possibly superior.

The Canadian study—conducted by Andrew W. Howard, MD, and colleagues and presented by Dr. Howard at the 2010 annual meeting of the Pediatric Orthopaedic Society of North America (POSNA)—evaluated splints versus casts in fractures that had an angulation deformity of 15 degrees or less.

Dr. Howard noted that level I evidence has previously demonstrated that short-arm splinting is superior to short-arm casting for nondisplaced fractures. In this randomized, controlled single-center trial, using a single, blinded evaluator, investigators followed 93 patients, aged 5 to 12 years, with greenstick or complete fracture in the distal third of the radius. No nondisplaced fractures, buckle fractures, growth plate fractures, or displaced fractures with greater than 15 degrees angulation deformity were included.

Clinical evaluation was done after 4, 6, and 12 weeks of treatment. The primary outcome criterion was physical function at 6 weeks as measured by Activity Scale for Kids (ASK) score; secondary criteria included angulation on radiograph, range of motion, grip strength, pain, and preference of the patient and parents.

Baseline angulation for the two groups was approximately the same; the outcome angles were 9.8 degrees with splint and 8.2 degrees with cast (p = 0.35). ASK scores at 6 weeks were 92.8 in the splint group and 91.4 in the cast group, a difference neither clinically nor statistically significant.

Complications did not vary between groups, nor did range of motion, with the exception that pronation was slightly better (84 degrees versus 74 degrees) in the splint group at the end of treatment. No patient required any surgical procedure.

Among the splint wearers, 94 percent of the patients wore the splint “always” and 4 percent wore it “often” during the first week (with the remainder wearing it “sometimes”); by week 4, 57 percent wore it “always” and 33 percent wore it “often.”

Parents preferred splinting over casting, as did the children.

The authors concluded: “The benefits of splinting over casting have been previously established for undisplaced radius and ulnar fractures. This is the first study that extends these benefits to the large group of children with minimally displaced distal radius fractures. Splint treatment simplifies care for children, reduces cost, and improves short-term outcomes.”

The authors reported no conflicts.

Terry Stanton is the senior science writer for AAOS Now. He can be reached at tstanton@aaos.org

Bottom Line

  • A prefabricated wrist splint was found to be as effective as a cast in treating skeletally immature children who have minimally displaced (no more than 15 degrees) distal radius and/or ulnar fractures.
  • Splinting is preferred by both parents and patients, is less expensive than casting, and simplifies treatment.

Splints as good as casts in some wrist fractures