Management of Pediatric Buckle Fractures

Immediate Management: Finger Motion Only

• Active finger motion exercises should begin immediately following diagnosis to prevent hand stiffness, which is one of the most functionally disabling complications of distal radius fractures 1, 2
• Finger motion does not adversely affect an adequately stabilized distal radius fracture regarding reduction or healing 1
• Instructing patients at the first encounter to move fingers regularly through complete range of motion is extremely cost-effective and prevents complications that are difficult to treat after fracture healing 1

Wrist ROM Timing: Not Routinely Needed Early

• Early wrist motion is not routinely necessary following stable fracture fixation, as buckle fractures are inherently stable injuries 1, 3
• For surgically stabilized distal radius fractures, wrist mobilization typically begins at 1-3 weeks depending on fixation method, but buckle fractures are treated conservatively with immobilization only 1

Key Clinical Pitfalls

• Do not restrict finger motion - failure to encourage early finger motion leads to significant stiffness that requires multiple therapy visits and possibly surgical intervention 1, 4
• Wrist ROM exercises can reasonably begin after the 3-week immobilization period ends, coinciding with splint removal and return to normal activities 3