by Anthony J. Brown, MD

Last Updated: 2008-04-25 10:45:16 -0400 (Reuters Health)

NEW YORK (Reuters Health) – A review of trial data suggests that removable splints offer a more tolerable, but equally effective alternative to casts in treating minor fractures of the wrist in children.

A review of 10 randomized or quasi-randomized trials involving 827 children suggests that removable splints, either plastic or plaster, generally keep the fractures aligned as well as casts, but with greater comfort and less restriction, allowing children to bathe and participate in other activities.

The findings, which appear in the April 16th online issue of The Cochrane Library, also suggest that above-elbow casts are no better than less-restrictive below-elbow casts. Arm position in above-elbow casts had no effect on the risk of deformity, according to the results of one trial.

Percutaneous wire fixation helps prevent fracture redisplacement, three trials found, but it is unclear if this intervention actually improves function.

"There are minor, or buckle, fractures of the wrist, particularly in toddlers and preschool infants, that are currently being over-treated with a plaster cast and clinical follow-up," lead author Dr. Alwyn Abraham, an orthopedic surgeon with Leicester Royal Infirmary in the UK, said in a statement. "Provided these are accurately diagnosed in an emergency department, these minor fractures can be treated with a removable splint. Removal can be done at home with no further follow-up."

However, according to Dr. Leon Benson, spokesman for the American Academy of Orthopedic Surgeons, the ability to remove these splints, which makes them more comfortable and may help patients avoid a clinic visit, is also their biggest problem.

"Yes, you can treat a child’s buckle fracture with a splint, but I don’t," Dr. Benson said in a statement. "In my experience, a child under 10 is not going to keep a splint on, and who is going to take responsibility for that fact — the doctor? And, given that fact, what parent wants to sit on pins and needles waiting for it to happen when a safe plaster cast insures it won’t?"

The Cochrane Library 2008.

Copyright Reuters 2008.