O1072: Trends in Management of Pediatric Distal Radius Buckle Fractures

Background: Distal radius buckle fractures (DRBFx) represent nearly half of pediatric wrist injuries. DRBFx are stable injury patterns that can typically be successfully managed with brief immobilization. The purpose of this study was to evaluate opinions and preferences of pediatric orthopaedic specialists regarding the management of DRBFx.

Methods: The POSNA Trauma Quality, Safety, and Value Initiative (QSVI) Committee developed a 20-question survey regarding the treatment of DRBFx in children. The survey was sent twice to all active and candidate POSNA members in June 2020 (n=1487). Questions focused on various aspects of treatment, including type and length of immobilization, follow-up and radiographs and on potential concerns regarding patient/family satisfaction and pain control, medicolegal concerns, misdiagnosis, and mismanagement.

Results: 317 participants completed the survey (response rate=21.3%) (Table 1). 69% of all respondents prefer to use a removable wrist splint, with 76% of those in practice fewer than 20 years preferring removable wrist splints compared to 51% of those in practice greater than 20 years (2=21.7; p< 0.01). (Table 2)
85% of participants utilize shared-decision making in discussing management options with patients and their families. The majority of participants felt that the risk of complications associated with DRBFx was very low, but misdiagnosis and mismanagement have required some respondents to perform closed or open reductions.

Conclusion: In 2020, the majority of respondents treat DRBFx with removable splints (69%), for three or fewer weeks (55%), minimal follow-up (85%) and no re-imaging (64%). This marks a dramatic shift from the 2012 survey (Boustis, 2015) when only 29% of respondents used removable splinting for DRBFx.