Plint removable splint vs cast

A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children.

Plint AC, Perry JJ, Correll R, et al. Pediatrics 2006 · PMID 16510648 · doi:10.1542/peds.2005-0801

Question

Does a removable wrist splint give better function than a cast for children with distal radius buckle fractures?

Design

Single-centre randomised controlled trial in a Canadian paediatric emergency department.

Patients

Children aged 6 to 15 years with buckle fractures of the distal radius and/or ulna.

Intervention

Removable prefabricated wrist splint

Comparison

Short arm cast for 3 weeks

Primary outcome

Physical functioning on the Activities Scale for Kids (performance) at 14 days

Key result

Splinted children had better physical function at 2 weeks and less difficulty with daily activities such as bathing than those in casts, with similar pain and no refractures in either group.

Limitations

Single-centre trial with a modest sample and notable loss to analysis; outcomes were self-reported by unblinded families.

Impact on practice

Early evidence underpinning the move away from casting buckle fractures towards removable splints, later reflected in NICE NG38 and extended by FORCE.