Splint May Work as Well as Cast for Kids' Wrist Fractures

NEW YORK – A splint may work just as well as a cast in helping children with non-severe wrist fractures heal, a study published Tuesday suggests.

The findings, researchers say, should encourage parents to ask their doctor whether a splint -- which is removable and more convenient than a cast -- is an option for their child's broken wrist.

Wrist fractures are the most common type of bone break children suffer, and the typical treatment involves wearing a short arm cast for four to six weeks. However, some studies in adults have suggested that splints may be a good alternative.

For the new study, researchers at the Hospital for Sick Children in Toronto, Canada, tested the effects of splinting versus casting among 96 five- to twelve-year-old children with "minimally angulated" wrist fractures. With these fractures, there is no major bending or displacement of the bone, and usually no need for a surgeon to realign it before the cast is placed.

Of the children, 46 were randomly assigned to wear an off-the-shelf splint and 50 a short arm cast for four weeks. Children with splints were told to remove them only for bathing or other hygienic reasons.

When the researchers assessed the children two weeks after the splint or cast was removed, they found no substantial differences between the two groups as far as the daily activities the children could perform.

The splint and cast groups were also similar in terms of range of motion, grip strength and the degree of pain improvement.

Nor were there clear differences in complication rates, according to findings reported in the Canadian Medical Association Journal.

Three children in each group had to wear their device for six weeks because exams at the four-week mark showed that the degree of bending in the fractured bone had worsened. No child ended up needing surgery during the three-month follow-up period, however.

One child in the splint group developed a rash and needed to have a cast placed. But overall, a similar number of children in each group reported minor side effects.

Itchiness was the most common complaint (reported by 88 percent of children in the splint group, and 72 percent in the cast group), followed by irritation (60 percent in the splint group, and 40 percent in the cast group). Those differences were not significant in statistical terms.

There are a number of advantages that splints have over casts for children's wrist fractures, according to lead researcher Dr. Kathy Boutis, a staff physician at the Hospital for Sick Children.
Splints make hygiene easier and allow children to scratch the itchiness that so often comes with an immobilized injury, Boutis told Reuters Health in an email. And, unlike casts, she pointed out, splints do not require a saw for removal -- which can be a scary experience for younger children.
In this study, splints were clearly more popular.

While all parents were satisfied with the appearance of their child's wrist after treatment, most parents (60 percent) and most children (68 percent) in the cast group said they would have preferred a splint. Few parents and kids in the splint group would have preferred the cast option.

Typically, when children are taken to the emergency room for wrist fractures, the injury is set in a temporary "plaster of Paris" splint, Boutis explained. A few days later, the child will have a cast placed, often at a fracture clinic or by an orthopedics specialist in another setting.

In such settings, splints are likely to be an option too. "Parents are encouraged to ask their child's orthopedic surgeon if a splint is a suitable option for their child's fracture," Boutis said.

She noted, though, that in some ERs, a cast might be placed right away, and few emergency departments stock pre-fabricated splints.

"In time," Boutis said, "our hope is that orthopedic surgeons and emergency department physicians will work together to create a management pathway for these fractures so that the pre-fabricated splint option will be available to patients in emergency departments and clinics."

Splints may not, however, be appropriate for children with more-severe wrist fractures, according to Boutis.

"These injuries are often more unstable and likely require an orthopedic surgeon to move the bone back in place before a cast is applied," she said.