How to deal with broken wrists

A shift to splints?

September is here – a month when kids tend to break their wrists more than most others. A trip to the ER usually ends up with the unfortunate child garnering a heavy, new accoutrement – a cast. After 6 weeks of itchy discomfort and the sight of a scary saw used to take off the cast, said child’s almost good as new.

A new study done at the Hospital for Sick Children in Toronto has shown there may be a better way ( http://www.cmaj.ca/cgi/content/abstract/cmaj.100119v1 ). For kids with minimally angulated fractures of the distal radius, using a splint instead of a short arm cast was equally effective. The 96 5- to 12-year olds had similar range of motion, grip strength, degree of improvement, and complications at the end of therapy. However, the splint group could also remove the pre-fab splints to take a bath.

A previous study on 113 6- to 15-year olds with uncomplicated ulna buckle and/or distal radius fractures also concluded that splints were preferable for these types of fractures in children ( http://pediatrics.aappublications.org/cgi/content/full/117/3/691 ).

Right now, the Ontario healthcare system doesn’t cover the cost of prefabricated splints, but they’re cheaper than fiberglass casts and can be made out of plaster of Paris. “You can make them any size you want,” says Dr. Joe Hyndman of Halifax’s IWK Health Centre, a long-time veteran of treating kids’ fractures.

And, Dr. Kathy Boutis, an ER doc at SickKids and the study’s co-author, is confident that staff members will adopt this treatment quickly, considering her study’s results.

Most of the injured kids — and their parents — preferred the ease and versatility of the splints. Considering the comparable physical function the children enjoyed, which was measured by the Activities Scale for Kids (ASK) ( http://www.activitiesscaleforkids.com/ ) after their splints were removed, this shift in treatment seems like a no-brainer.
Milena Katz
Canadian Medicine

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