3/15/2023 0 Comments Buckle fracture wristOne study (233 children) found full restoration of physical function at four weeks low‐quality evidence. Removal of casts at home by parents versus at the hospital fracture clinic by clinicians (2 studies, 404 children, mainly buckle fractures) More bandage‐group participants found their treatment convenient (39 children). Evidence was absent, insufficient or contradictory for recovery time, wrist pain, children with minor complications, and child and parent satisfaction. Two studies (139 children) reported no serious adverse events at four weeks. Eight children changed device or extended immobilisation for delayed union (bandage 5/90 cast 3/91 3 studies) very low‐quality evidence. One study (53 children) reported more children had no or only limited disability at four weeks in the bandage group very low‐quality evidence. Soft or elasticated bandage versus below‐elbow cast for buckle or similar fractures (4 studies, 273 children) Two studies estimated lower healthcare costs for removable splints. Evidence was absent (recovery time), insufficient (children with minor complications) or contradictory (child or parent satisfaction). One study (50 children) found no between‐group difference in pain during treatment very low‐quality evidence. One study (87 children) reported no refractures at six months. Thirteen children needed a change or reapplication of device (splint 5/225 cast 8/219 4 studies) very low‐quality evidence. One study (66 children) reported similar Modified Activities Scale for Kids ‐ Performance scores (0 to 100 no disability) at four weeks (median scores: splint 99.04 cast 99.11) low‐quality evidence. Removable splint versus below‐elbow cast for predominantly buckle fractures (6 studies, 695 children) Below we consider five prespecified comparisons: All studies were at high risk of bias, mainly reflecting lack of blinding. Eight studies recruited buckle fractures, five recruited buckle and other stable fractures, three recruited minimally displaced fractures and 14 recruited displaced fractures, typically requiring closed reduction, typically requiring closed reduction. Typically, trials included more male children and reported mean ages between 8 and 10 years. ![]() Of the 30 included studies, 21 were RCTs, seven were quasi‐RCTs and two did not describe their randomisation method. We pooled data where appropriate and used GRADE for assessing the quality of evidence for each outcome. Data collection and analysisĪt least two review authors independently performed study screening and selection, 'Risk of bias' assessment and data extraction. ![]() We sought data on physical function, treatment failure, adverse events, time to return to normal activities (recovery time), wrist pain, and child (and parent) satisfaction. We included randomised controlled trials (RCTs) and quasi‐RCTs comparing interventions for treating distal radius fractures in children. We searched the Cochrane Bone, Joint and Muscle Trauma Group's Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, trial registries and reference lists to May 2018. ![]() To assess the effects (benefits and harms) of interventions for common distal radius fractures in children, including skeletally immature adolescents. There is considerable variation in practice, such as the extent of immobilisation for buckle fractures and use of surgery for seriously displaced fractures. Most are buckle fractures, which are stable fractures, unlike greenstick and other usually displaced fractures. Wrist fractures, involving the distal radius, are the most common fractures in children.
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