Interventions for treating wrist fractures in children

• Published in: Cochrane database of systematic reviews 2018-12, Vol.12 (12), p.CD012470
• Main Authors: Handoll, Helen Hg, Elliott, Joanne, Iheozor-Ejiofor, Zipporah, Hunter, James, Karantana, Alexia
• Format: Article
• Language: English
• Subjects: Adolescent; Bandages - statistics & numerical data; Child; Child health; Female; Fracture Fixation - adverse effects; Fracture Fixation - methods; Fracture Healing; Fractures of the distal radius and ulna; Humans; Immobilization - methods; Immobilization - statistics & numerical data; Male; Orthopaedics & trauma; Pain Measurement; Radius Fractures - therapy; Randomized Controlled Trials as Topic; Splints - statistics & numerical data; Time Factors; Treatment Failure; Wrist Injuries
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012470.pub2

Wrist fractures, involving the distal radius, are the most common fractures in children. Most are buckle fractures, which are stable fractures, unlike greenstick and other usually displaced fractures. There is considerable variation in practice, such as the extent of immobilisation for buckle fractures and use of surgery for seriously displaced fractures. To assess the effects (benefits and harms) of interventions for common distal radius fractures in children, including skeletally immature adolescents. 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. We included randomised controlled trials (RCTs) and quasi-RCTs comparing interventions for treating distal radius fractures in children. 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. At least two review authors independently performed study screening and selection, 'Risk of bias' assessment and data extraction. We pooled data where appropriate and used GRADE for assessing the quality of evidence for each outcome. Of the 30 included studies, 21 were RCTs, seven were quasi-RCTs and two did not describe their randomisation method. Overall, 2930 children were recruited. Typically, trials included more male children and reported mean ages between 8 and 10 years. 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. All studies were at high risk of bias, mainly reflecting lack of blinding. The studies made 14 comparisons. Below we consider five prespecified comparisons:Removable splint versus below-elbow cast for predominantly buckle fractures (6 studies, 695 children)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. Thirteen children needed a change or reapplication of device (splint 5/225; cast 8/219; 4 studies); very low-quality evidence. One study (87 children) reported no refractures at six months. One study (50 children) found no between-group difference in pain during treatment; very low