American Medical Society for Sports Medicine

View all recommendations from this society

Released March 29, 2022

Do not cast or perform follow-up x-rays for isolated, non-displaced/non-angulated distal radius buckle fractures that do not involve the physis and which have an intact cortex in children.

Distal radius buckle fractures are one of the most common wrist fractures in children. These fractures are inherently stable and have an excellent prognosis. As long as the following conditions are met, radius buckle fractures can be safely treated with a Velcro removable wrist splint for 3-4 weeks as long as:

  1. Cortex is intact.
  2. There are no fracture lines extending to the physis on any view.
  3. There is no angulation/displacement of the fracture.
  4. There are 2 or 3 inflection points seen in the cortex on either view which best represents the fracture.
  5. The parent can do a symptom check with instructions.

Treating in a cast and repeating x-rays increases healthcare costs as well as radiation exposure for the patient. Parent satisfaction is also increased when these fractures are treated with a brace.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Medical Society for Sports Medicine (AMSSM) has identified this list of clinical recommendations for the Choosing Wisely® campaign. The goal was to identify common topics in the practice of sports medicine that, supported by a review of the literature, would lead to significant health benefits and a reduction of common procedures that can be unnecessary or cause harm. For each item, evidence was reviewed from peer-reviewed literature and several sports medicine consensus statements. The list was initially generated and drafted by AMSSM’s Quality Measures Subcommittee. It was then edited and approved by AMSSM’s Practice and Policy Committee and the Board of Directors.

The American Medical Society for Sports Medicine’s disclosure and conflict of interest policy can be found at www.amssm.org.

Sources

Little K, Godfrey J, et al. Increasing Brace Treatment for Pediatric Distal Radius Buckle Fractures: using Quality Improvement Methodology to Implement Evidence-based Medicine. Journal of Pediatric Orthopedics 2019 September; 39(8): e586-e591.

Kuba M, Izuka B. One Brace: One Visit: Treatment of Pediatric Distal radius Buckle Fractures with a Removable Wrist Brace and No Follow-up Visit. Journal of Pediatric Orthopedics 2018 July; 38(6): e338-e342.

West S, et al. Buckle Fractures of the Distal Radius Are Safely Treated in a Soft Bandage. Journal of Pediatric Orthopedics 2005 May/June; 25(3): 322-325.