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Acute buckle fracture wrist9/28/2023 ![]() A cast is usually added a few days to a week or so later, after the swelling goes down. A splint is usually used for the first few days to allow for a small amount of normal swelling. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.Īfter the bone is properly aligned, a splint or cast may be placed on your arm to keep the bones aligned. Reduction is the technical term for the process in which the doctor moves the broken pieces into place. If your broken bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. If the broken bone is in a good position, a cast may be applied until the bone heals. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's best judgment. There are many treatment options for a distal radius fracture. The treatment of broken bones follows one basic rule: The broken pieces must be put back into position and prevented from moving out of place until they are healed. Depending on the type of distal ulna fracture, you may or may not require additional treatment. Sometimes, the other bone of the forearm (the ulna) is also broken. ![]() It is important to classify the type of fracture because intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight) are more difficult to treat than other types of fractures. Comminuted fracture - When a bone is broken into more than two pieces, it is called a comminuted fracture.These types of fractures require immediate medical attention because of the risk for infection. Open fracture - When a fractured bone breaks the skin, it is called an open fracture.Extra-articular fracture - A fracture that does not extend into the joint is called an extra-articular fracture.Intra-articular fracture - An intra-articular fracture is one that extends into the wrist joint.Other ways the distal radius can break include: ![]() Samora is currently collaborating with the Department of Radiology at Nationwide Children’s to systematically report these injuries.A Colles fracture occurs when the broken end of the radius tilts upward. A radiology report that standardizes how the fractures are described may allow the emergency department or urgent care providers to apply Velcro splints without a specialist referral. Ultimately, it may be possible for children with these fractures to avoid a visit to orthopaedics altogether. Even for those children, orthopedic specialists at Nationwide Children’s now prefer a splint, but families have the option to choose what works best for them. Some families feel that because of the child’s activity level, or because of sports played, a cast may offer more protection. The only reason the splint rate isn’t 100 percent is parent preference, according to Dr. It also saves time for families, because the patients do not have to come back and see us again.” It minimizes radiation exposure, because no repeat radiographs are needed, and it eliminates any risk of cast complications. “Changing our practice saves money not only for families but also for the health care system. “It’s the right thing to do,” says Julie Balch Samora, MD, PhD, hand and upper extremity surgeon and director of quality improvement in the Department of Orthopaedics. This does not include the costs to families for time off work for a return visit to the orthopedic clinic. Applying a splint instead of a cast saved an estimated $86,118 in health care costs. By December 2016, more than 90 percent of patients at Nationwide Children’s were treated with braces instead of casts.Ī total of 231 patients were seen with buckle fractures in the first several months of the project. The standard of care changed in March 2016. In the five months before the project began, 20 percent of Nationwide Children’s orthopedic patients with distal radius buckle fractures were treated with the removable braces. So the Department of Orthopaedics at Nationwide Children’s changed its practice, in a collaborative project with Cincinnati Children’s Hospital Medical Center (CCHMC). Research in the last decade has demonstrated that alternative, removable splinting results in similar outcomes for these stable wrist fractures, while reducing costs and eliminating the need for follow-up orthopedic visits and radiographs. A 2015 multi-institutional study found that more than 70 percent of pediatric orthopedic specialists use this as their standard of care, and until the spring of 2016, Nationwide Children’s Hospital did as well. ![]() The traditional treatment for distal radius buckle fractures involves immobilization in a short- or longarm cast.
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