Commentary

Charles T. Mehlman

$Symons et al. have asked the question: can parents of pediatric patients safely perform part of their child's fracture care? The answer appears to be a qualified "yes." First, the entire treatment algorithm depends on proper classification of buckle fractures. Although the rate of agreement among orthopaedic practitioners can be high (Kappa = 0.81) when classifying fractures of the distal radius as buckle, greenstick, or complete 1 , when pediatric radiologists use the term "buckle fracture," as many as 16% of these fractures involve complete cortical disruption 2 . Second, buckle fractures may displace 1 , 3 , although this is rare 4 . Displacement may be related to the difficulties in detecting complete cortical disruption on initial plain radiographs or to other factors such as new trauma. Up to 2.5% of buckle fractures will displace with an average angulation of about 11° (range, 7° to 17°). The study by Symons et al. involved too few children to allow detection of this rare fracture displacement. We can only guess, but it is likely that thousands of buckle fractures would have to be examined before one was found to be displaced enough to warrant reduction or other corrective measures. <h2>References</h2>$

Commentary

Mehlman, Charles T.

Follow Journal of Bone and Joint Surgery , Volume 84 (5): 883 JB&JS – May 1, 2002