Methodology: 4/5
Usefulness: 4.5/5

Perry DC, et al. Lancet. 2022 Jul 2;400(10345):39-47.

Question and Methods: This large, multicentre, pragmatic RCT aimed to show equivalence between treating pediatric buckle fractures of the distal radius with soft bandage versus rigid immobilisation.
Findings: With 965 participants, equivalence demonstrated for primary outcome of pain at day 3 (average pain scores 3.21 vs 3.14, adjusted difference -0.10 [95% CI -0.37 to 0.17]). Mild, transient increased analgesia use and decreased parental satisfaction in intervention group on day 1.
Limitations: An inability to blind participants, a clear patient/parent preference for rigid immobilisation, and a high cross-over rate between intervention groups.

Interpretation: Supports offering a soft bandage for distal radius buckle fractures instead of the usual practice pattern of rigid immobilization up to 3 weeks.

By: Dr. Caitlin Hutchings

JC Supervisor: Dr. Debra Eagles