A Cochrane review [Abstract] 1 [withdrawn from publication] included 10 studies with a total of 827 subjects. Four trials compared removable splintage versus the traditional below-elbow cast in children with buckle fractures. There was no short-term deformity recorded in all four trials and, in one trial, no refracture at six months. The Futura splint was cheaper to use; a removable plaster splint was less restrictive to wear enabling more children to bathe and participate in other activities, and the option preferred by children and parents; the soft bandage was more comfortable, convenient and less painful to wear; home-removable plaster casts removed by parents did not result in significant differences in outcome but were strongly favoured by parents.
Two trials found below-elbow versus above-elbow casts did not increase redisplacement of reduced fractures or cast-related complications, were less restrictive during use and avoided elbow stiffness.
One trial evaluating the effect of arm position in above-elbow casts found no effect on deformity.Three trials found that percutaneous wiring significantly reduced redisplacement and remanipulation but one of these found no advantage in function at three months.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear blinding) and by inconsistency (heterogeneity in interventions and outcomes).
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