Summary of findings 2. Summary of findings. Bandage versus cast.

Bandage versus below‐elbow cast for buckle or minimally displaced fracture in children
Patient or population: children with stable wrist fracture, predominantly buckle (torus) fracturesa Settings: hospital clinic Intervention: Soft or elasticated bandageb for 3 to 4 weeks Comparison: Below‐elbow cast for 3 to 4 weeks
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Below‐elbow cast	Bandage
Physical function (short‐term): no problems or only 'limited disability' (see Comments) (4 to 6 weeks follow‐up)	500 per 1000c	895 per 1000 (590 to 1000)	RR 1.79 (1.18 to 2.73)	53 (1 study)	⊕⊝⊝⊝ very lowd	'Limited disability' applied to 1 of 5 areas: interference with play; help needed with feeding; help needed with washing and dressing; sleep disturbance; missed days of school
Treatment failure: (3 to 6 weeks follow‐up)	33 per 1000e	51 per 1000 (15 to 176)	RR 1.53 (0.44 to 5.32)	181 children (3 studies)	⊕⊝⊝⊝ very lowf	Parents of 4 children (4.4%) requested a change from bandage to cast; 3 because they were sore from overuse and 1 "special needs" child. There were no requests for change in the cast group. 1 trial reported 4 cases (1 in the bandage group versus 3 in the cast group) of delayed union requiring an extra week
Serious adverse events (3 to 4 weeks follow‐up)	See comment	See comment	Not estimable	139 children (2 studies)	See comment	No children developed a serious adverse event, including refracture, in these 2 studies. This is consistent with other evidence, including from other included trials with buckle fractures that explicitly reported the absence of serious adverse events (87 children from 1 study comparing removable splint versus cast; 288 children from 1 study comparing home versus hospital removal of casts)
Time to return to former activities	See comment	See comment	Not estimable	‐	See comment	This outcome was not reported
Pain with VAS (0 to 100; worst pain) at 1 week	The mean score in the study control group was 20	The mean score in the intervention group was 6 higher (1.31 lower to 13.31 higher)	‐	89 children (1 study)	⊕⊝⊝⊝ very lowg	The 95% CI is unlikely to include a clinically important effect. There was also very low‐quality evidence of less pain in the bandage group in 1 study (39 children), and little difference in pain during device use or requirement for analgesic in another study (53 participants)h
Minor complications (3 to 6 weeks follow‐up)	See comment	See comment	Not estimable	92 children (2 studies) (individual complications)	See comment	Complications reported were skin problems, increased deformity (minimal) and stiffnessi. Where reported, there was very low‐quality evidence of little or no difference between groups in the individual complications
Participant satisfaction: children found treatment was convenient (4 weeks follow‐up)	143 per 1000c	946 per 1000 (331 to 1000)	RR 6.61 (2.31 to 18.96)	39 children (1 study)	⊕⊝⊝⊝ very lowj	In this study, all 18 participants followed up in the bandage group had removed their bandage by 2 weeks
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; VAS: visual analogue scale
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

^aChildren had buckle fractures in two studies, "impacted greenstick" fractures in one study and either buckle or an "undisplaced greenstick" fracture in one study.
 ^bThe soft bandage was a wool layer covered with a cotton crepe bandage. The elasticated bandage was a tubigrip.
 ^cControl group risk is derived from the study data.
 ^dWe downgraded the evidence by two levels for very serious risk of bias, mainly reflecting lack of blinding (performance and detection biases), and by one level for serious indirectness for an inadequately reported outcome measure.
 ^eControl group risk is derived from the mean, since the median control risk (as in 2 studies) = 0.
 ^fWe downgraded the evidence by two levels for very serious risk of bias, mainly reflecting lack of blinding (performance and detection biases), and by two levels for very serious imprecision (few events, wide confidence interval).
 ^gWe downgraded by two levels for very serious risk of bias, reflecting lack of blinding (performance and detection biases), and by one level for imprecision for wide confidence intervals.
 ^hPain was measured in different ways: one study referred to a "semantic scale", one used a VAS and also reported in terms of requiring analgesics.
 ⁱOne study (39 children) reported an absence of skin problems; and one study (53 children) reported one child in each group had slightly increased deformity; the same trial found three children in the cast group had stiffness after cast removal. The data from one study (49 children) reporting four cases of delayed union requiring extended treatment are included under treatment failure.
 ^jWe downgraded by two levels for very serious risk of bias, reflecting lack of blinding (blinding and performance biases), by one level for serious imprecision reflecting the small sample size, and by one level for serious indirectness as the outcome was not a full measure of satisfaction.