This site is optimised for modern browsers. For the best experience, please use Google Chrome, Mozilla Firefox, or Microsoft Edge.

Bandages are as good as splints at treating child wrist fractures, study finds

Bandages are as good as rigid splints at treating wrist fractures in children, according to a new University of Oxford study funded by the National Institute of Health and Care Research (NIHR).

The ‘FOrearm fracture Recovery in Children Evaluation’ (FORCE) study found levels of pain, arm recovery, quality of life, complications and school absences were equal in children treated with a splint or a bandage.

It means doctors could simplify treatment for the most common fracture in children, reducing NHS costs.

Torus wrist fractures are the mildest and most common type of broken bone in children, affecting about 60,000 annually in the UK. The distal radius, the part of the forearm bone connected to the wrist joint, crushes or buckles instead of breaking.

Treatment varies and doctors prescribe plaster casts or hard splints to immobilise the wrist, or offer a bandage. No ‘standard’ treatment has been agreed.

The study, published in The Lancet, recruited 965 children aged four to 15 with a torus fracture, including 57 from the John Radclife and Horton General hospitals, Oxfordshire and 11 from the Royal Berkshire Hospital, Berkshire. They were randomly allocated to a bandage with no planned follow up or a rigid splint and the usual outpatient follow up.

A bandage was equally as good as restricting movement with a hard splint, the study found and had a smaller impact on quality of life, such as school absences.

Daniel Perry, Associate Professor, Orthopaedics and Trauma Surgery at the University of Oxford said: “It is a common belief amongst both families and clinicians that a fracture needs plaster cast immobilisation to ensure adequate healing. However, evidence suggested that a bandage or no treatment was just as effective. We started the FORCE trial because it was not clear how much difference each treatment made to a patient’s recovery.

“FORCE highlights the over-treatment that happens in many parts of practice. As doctors, we’ve always been taught to splint all broken bones, though in reality we know that many children with this injury present to hospital after several days as their parents considered it a wrist sprain, and indeed many almost certainly never come.

“As clinicians, we need to shift our mindset to consider buckle fractures as a wrist sprain and treat it with love and reassurance. With more research, perhaps we can move to a situation where we don’t even x-ray many wrist injuries in children.”

The study was funded by the NIHR Health Technology Assessment (HTA) Programme

Read more about the FORCE study on the NIHR website