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Buckle Up: Why Your Next Forearm Fracture Might Only Need Gauze

  • The Review Course in Family Medicine
  • 3 hours ago
  • 2 min read



With just a few weeks to go before the exam, I know you are feeling the heat.


I have taught a few resident groups in BC and Ontario this month and have heard how stressful it is studying for the 2026 Hybrid Exam.


Hopefully the update below will give a boost to your studying, and keep up the good work!

- Simon




Wrist management that won't make you snap.


As the 2026 Canadian Family Physician "Tools for Practice" article highlights, we might be over-treating one of our most common pediatric injuries, buckle fractures.


  • Similar function at six weeks with gauze.

  • Equivalent patient satisfaction scores.

  • Zero difference in long-term complications.


Before scrolling down, ask yourself: A 10-year-old presents with a stable, isolated distal radius buckle fracture. Aside from a soft bandage, what is the most critical activity restriction you must advise the parents about to prevent re-injury during the healing phase?


Children with buckle fractures heal beautifully, whether you use a soft bandage, a removable rigid splint, or a full cast. Evidence from two systematic reviews shows that by the one-month mark, these kids have the same physical function regardless of how "stiff" the initial wrap was. A cast might offer slightly better pain control on day one, but that advantage disappears within 24 hours.


Management: Use soft bandages (like stretchy gauze or elastic wraps) for isolated buckle fractures in the distal one-third of the radius. This applies even if the ulna is also involved, as long as there’s no cortical breakthrough or angulation. This approach is a win for everyone: parents can remove the bandage for bathing, and there is no need for a high-stress "cast saw" visit later.


The follow-up: Scheduled specialist appointments aren't mandatory. Home management with family physician follow-up "as needed" provides similar outcomes to scheduled reviews. If pain returns, simply reapply the bandage for one week. The goal is to return to play safely, while avoiding high-risk falling activities or "swinging" sports (like monkey bars) for about six weeks.


EXAM TIP: On a pediatric MSK SAMP, don't confuse a buckle fracture with a greenstick fracture. A buckle fracture has an intact cortex and can be managed with a soft bandage. A greenstick fracture involves a break on one side of the cortex and almost always requires rigid immobilization. Mixing these up could cost marks.



 
 
 

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