Splints as Good as Plaster Casts for Minor Fractures

But one expert says there's a hitch: Kids can take them off

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WEDNESDAY, April 16, 2008 (HealthDay News) -- A review of past research shows cheaper, removable splints are as safe and effective as traditional plaster casts for treating minor wrist fractures in children.

But one U.S. orthopedic expert disagrees, saying that kids may be tempted to take off the split at inappropriate times and cause further damage to themselves.

"Yes, you can treat a child's buckle fracture with a splint, but I don't," Dr. Leon Benson, spokesman for the American Academy of Orthopaedic Surgeons (AAOS), said in a prepared 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?"

Minor wrist, or buckle, fractures are common among children. They often occur when a child falls on an outstretched hand. Traditionally, physicians treat these incomplete bone fractures by covering the wrist to just below the elbow in a plaster cast for a short time, often about three weeks.

Of the 10 reviewed studies that compared plaster casting to removable splints in 827 children with wrist fractures, none reported a bone deformity in any patient. The review, conducted by British researchers, was published in the current issue of The Cochrane Library.

"There are minor, or buckle, fractures of the wrist, particularly in toddlers and preschool infants, which are currently being over-treated with a plaster cast and clinic follow-up," lead investigator Alwyn Abraham, a consultant orthopedic surgeon in pediatrics at the Leicester Royal Infirmary, said in a prepared 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."

Plaster casts that parents could remove at home also performed as well as traditional casts, and parents preferred these more, the researchers said. Children and parents also preferred the removable Futura-brand splint, which was less expensive and less restrictive.

Benson agreed with the reviews conclusions in theory, but not in practice.

"My experience is that the younger child's pain decreases dramatically more quickly with plaster casting than a splint, and adolescents in splints often remove them around their friends, because they find them embarrassing," said Benson, who is also an associate clinical professor of orthopedic surgery at the Northwestern University Feinberg School of Medicine. "With a plaster cast, everyone can sleep at night; nothing can make that cast fall off. Yes, having a plaster cast for a few weeks is a hassle in ways, though it is possible to cover it and bathe or shower. But for the whole child and the whole family, it is a more reasonable treatment."

Benson also said the economic implication of the findings could give parents no option that offered them peace of mind: "A review like this could be used, in the U.K. system, to force people to use cheaper splinting methods of treatment rather than have a choice for plaster-casting for their child for reasons beyond narrow measures of clinical efficacy. This would be unfortunate."

More information

Safe Kids Worldwide has safety tips to prevent childhood injuries.

SOURCE: Center for the Advancement of Health, news release, April 15, 2008

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