Does degree of immobilization influence refracture rate in the forearm buckle fracture?

The aim of this study was to determine whether the degree of immobilization (method, extent, duration of treatment) affects the risk of refracture in the management of forearm buckle fractures. We performed a comprehensive systematic review of prospective trials using accepted epidemiological methods. Studies were selected in step-wise manner, in duplicate, with critical appraisal of identified studies. Results are presented in a summary table with primary and secondary outcomes described. Of the 869 studies identified by the search strategy, five studies met all eligibility criteria. 455 participants were included. No refractures were reported in any of the studies during the treatment period, regardless of degree of immobilization. One study followed patients for 6 months and found no late refractures in 75 participants. In conclusion, treatment in a removable splint does not increase risk of refracture or late displacement during the treatment period for buckle fractures of the distal forearm. Long-term data on refracture rate is limited. There tends to be improved function, patient acceptance, and caregiver satisfaction with the use of removable splints. Further study is needed to determine whether there are differences for longer periods of follow-up on a population basis.