Cochrane · systematic review · CD012470
Interventions for treating wrist fractures in children
Handoll, HHG, Elliott, J, Iheozor‐Ejiofor, Z, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Bone, Joint and Muscle TraumaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
19
No studies
8
Included studies
NR
No studies 8 · 22.9%Ungraded 8 · 22.9%Very low 13 · 37.1%Low 6 · 17.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings. Removable splintage versus cast for buckle and other stable fractures
Population: children with stable wrist fracture, predominantly buckle (torus) fracturesa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical function (short‐term): measured using the Modified Activities Scale for Kids ‐ performance version (0 to 100; best function; no disability) (4 weeks Summary of findings. Removable splintage vs cast | no estimate extracted | 1 study · 65 participants | Low Downgraded: risk of bias, imprecision |
Treatment failure (4 weeks Summary of findings. Removable splintage vs cast | RR 0.71 [0.26, 1.89] | 4 studies · 444 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Serious adverse events (6 months Summary of findings. Removable splintage vs cast | no estimate extracted | 1 study · 87 participants | Ungraded |
Time to return to former activities Summary of findings. Removable splintage vs cast | no estimate extracted | NR | No studies |
Pain VAS (0 to 10; worst pain) during device use (4 ‐ 6 weeks Summary of findings. Removable splintage vs cast | no estimate extracted | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Minor complications (3 to 6 weeks Summary of findings. Removable splintage vs cast | no estimate extracted | 5 studies · 500 participants | Ungraded |
Participant satisfaction: child and/or parent preference for same device in future (3 to 6 weeks Summary of findings. Removable splintage vs cast | no estimate extracted | 2 studies · 178 participants | Ungraded |
Summary of findings. Bandage versus cast
Population: children with stable wrist fracture, predominantly buckle (torus) fracturesa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical function (short‐term): no problems or only 'limited disability' (see Comments) (4 to 6 weeks Summary of findings. Bandage vs cast | RR 1.79 [1.18, 2.73] | 1 study · 53 participants | Very low Downgraded: risk of bias, indirectness |
Treatment failure: (3 to 6 weeks Summary of findings. Bandage vs cast | RR 1.53 [0.44, 5.32] | 3 studies · 181 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events (3 to 4 weeks Summary of findings. Bandage vs cast | no estimate extracted | 2 studies · 139 participants | Ungraded |
Time to return to former activities Summary of findings. Bandage vs cast | no estimate extracted | NR | No studies |
Pain with VAS (0 to 100; worst pain) at 1 week Summary of findings. Bandage vs cast | no estimate extracted | 1 study · 89 participants | Very low Downgraded: risk of bias, imprecision |
Minor complications (3 to 6 weeks Summary of findings. Bandage vs cast | no estimate extracted | 2 studies · 92 participants | Ungraded |
Participant satisfaction: children found treatment was convenient (4 weeks Summary of findings. Bandage vs cast | RR 6.61 [2.31, 18.96] | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Summary of findings. Below‐elbow versus above‐elbow cast
Population: children with either displaced distal radius fracture with intact or displaced ulna fracture (both‐bone fracture), or minimally displaced bone metaphyseal fracture
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical function (short‐term; under 3 months) Summary of findings. Below‐elbow vs above‐elbow cast | no estimate extracted | NR | No studies |
Physical function (medium‐term; 3 to 12 months): measured using the ABILHAND‐Kids score (0 to 42: no problems) (6 months Summary of findings. Below‐elbow vs above‐elbow cast | no estimate extracted | 1 study · 66 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
'Treatment failure': secondary procedures such as remanipulation for early loss of position (only data for this used here); and change in treatment ( Summary of findings. Below‐elbow vs above‐elbow cast | RR 0.27 [0.07, 1.06] | 4 studies · 366 participants | Very low |
Serious adverse events ( Summary of findings. Below‐elbow vs above‐elbow cast | no estimate extracted | 2 studies · 215 participants | Ungraded |
Time to return to former activities Summary of findings. Below‐elbow vs above‐elbow cast | no estimate extracted | NR | No studies |
Pain after 1 week in cast: VAS (0 to 10: worst pain) ( Summary of findings. Below‐elbow vs above‐elbow cast | no estimate extracted | 1 study · 85 participants | Low Downgraded: risk of bias, indirectness |
Minor complications.,j,k Here represented by Referral for physical therapy for range of motion limitation (post‐immobilisation after 4 weeks) Summary of findings. Below‐elbow vs above‐elbow cast | RR 0.73 [0.19, 2.84] | 2 studies · 179 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings. Surgery (percutaneous wire fixation) versus not surgery (cast only)
Population: children with displaced distal radius fracture with intact or involved or displaced ulna fracture (both‐bone fracture)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical function (short‐term; under 3 months) Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | no estimate extracted | NR | No studies |
Physical function (medium‐term; 3 to 12 months) measured using the ABILHAND‐Kids score (0 to 42: no problems) (6 months Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | no estimate extracted | 1 study · 123 participants | Low Downgraded: risk of bias, imprecision, indirectness |
'Treatment failure': various secondary procedures such as remanipulation for early loss of position; early or more complex wire removal ( Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | RR 0.52 [0.33, 0.83] | 4 studies · 253 participants | Very low |
Serious adverse events (typically more serious complications) ( Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | RR 0.68 [0.45, 1.02] | 4 studies · 253 participants | Very low Downgraded: risk of bias, indirectness |
Time to return to former activities Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | no estimate extracted | NR | No studies |
Wrist pain Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | no estimate extracted | NR | No studies |
Minor complications (less serious).j Here represented by referral for physical therapy for range of motion limitation (post‐immobilisation after 4 weeks) Summary of findings. Surgery (percutaneous wire fixation) vs not surgery (cast only) | RR 0.65 [0.44, 0.97] | 1 study · 128 participants | Very low Downgraded: risk of bias, indirectness |
Summary of findings. Home versus hospital‐clinic removal of casts
Population: children with stable wrist fracture, predominantly buckle (torus) fractures
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical function (short‐term) measured using the Childhood Health Assessment Questionnaire (CHAQ) Index change scores from pre‐injury at 4 weeks ‐ VAS (probably 0 to 100; worst) Summary of findings. Home vs hospital‐clinic removal of casts | no estimate extracted | 1 study · 233 participants | Low Downgraded: risk of bias, imprecision |
Treatment failure (change in treatment) (6 weeks Summary of findings. Home vs hospital‐clinic removal of casts | RR 3.16 [0.5, 19.93] | 2 studies · 397 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events (6 months Summary of findings. Home vs hospital‐clinic removal of casts | no estimate extracted | 1 study · 288 participants | Ungraded |
Time to return to former activities Summary of findings. Home vs hospital‐clinic removal of casts | no estimate extracted | NR | No studies |
Pain (CHAQ) via VAS (0 to 100; worst pain) at 4 weeks Summary of findings. Home vs hospital‐clinic removal of casts | no estimate extracted | 1 study · 233 participants | Low Downgraded: risk of bias, imprecision |
Minor complications (4 to 6 weeks Summary of findings. Home vs hospital‐clinic removal of casts | no estimate extracted | 1 study · 80 participants | Ungraded |
Participant satisfaction: Parents would not choose the same treatment again (6 weeks Summary of findings. Home vs hospital‐clinic removal of casts | RR 0.16 [0.06, 0.43] | 1 study · 80 participants | Low Downgraded: risk of bias, imprecision |