Pediatric Orthopaedic Surgeon Use of Removable Splints for Common Pediatric Distal Radius and Fibula Fractures: A 10-year Update.

BACKGROUND: Management of pediatric fractures continually evolves, with a documented shift toward removable devices, such as splints, braces, or boots, for stable injuries. However, there is a need to evaluate current practice patterns.

METHODS: A self-administered, 22-question online survey was open to all practicing orthopaedic surgeon members of Pediatric Orthopaedic Surgeons of North America (POSNA) between June and September 2025. Questions were consistent with a previous 2015 survey. Demographic information, immobilization practices, comfort with removable devices, complications, and barriers were analyzed and compared with 2015 data.

RESULTS: A total of 323/865 (37.3%) invitees responded, with well-distributed experience levels, and 165 (56.9%) belonged to a university-affiliated practice. A total of 293 (95.1%) completed their pediatric fellowship, and 132 (45.4%) reported that their practice has an accepted standard of treatment for these fractures. A total of 256 respondents (87.7%) would treat distal radius buckle fractures with a removable device, which is significantly different than 2015, when 29.1% of respondents would treat these injuries with a removable device (P<0.001). Removable devices were not commonly used for greenstick [40 (13.7%)] or transverse [5 (1.7%)] fractures. Cast utilization decreased in both radius and fibula fractures, with the most pronounced reduction observed in distal fibula avulsion fractures, declining over 9-fold. Respondents were likely to prescribe a cast in 5.9% of fibula avulsion fractures, followed by 17.0% in Salter-Harris I and 38.5% in Salter-Harris II fractures. Concerns regarding patient family preference 170 (58.0%), patient compliance 158 (53.9%), and complications 91 (31.1%) are the most common reported barriers to using a removable form of immobilization. Although patient complications were listed as a potential barrier for 91 (31.1%) respondents, the perceived risk of complications was reported as "very low" for distal radius buckle [280 (96.2%)] and greenstick [91 (31.4%)] fractures. Transverse fractures were considered to have a moderate risk for complications [130 (44.8%)].

CONCLUSIONS: Compared with 2015, an increased utilization of removable devices for minimally displaced common pediatric fractures was seen. Barriers were patient or family compliance and preference, and concern for potential complications, highlighting the importance of education and shared decision-making.

CLINICAL RELEVANCE: It is important to evaluate the current state of evidence-based practice regarding the use of removable devices for pediatric fractures. Addressing barriers such as patient and family compliance, preferences, and concerns about complications through targeted education may improve adherence and optimize clinical outcomes.