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
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 lowc	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)d
Discomfort during use of device (up to 4 weeks)	572 per 1000e	58 (6 to 389)	RR 0.10 (0.01 to 0.68)	39 children (1 study)	⊕⊝⊝⊝ very lowf	Another study (89 participants at 1 week) also reported "significantly less" discomfort in the bandage group; mainly in relation to itchingg
Patient experience: children found treatment was convenient (4 weeks follow‐up)	143 per 1000e	946 per 1000 (331 to 1000)	RR 6.61 (2.31 to 18.96)	39 children (1 study)	⊕⊝⊝⊝ very lowh	In this study, all 18 participants followed up in the bandage group had removed their bandage by 2 weeks
Time to return to former activities	See comment	See comment	Not estimable	‐	See comment	This outcome was not reported
Skin problems	See comment	See comment	Not estimable	‐	See comment	1 trial (39 participants) reported no skin problems
Serious adverse events: refracture	See comment	See comment	Not estimable	‐	See comment	No children developed a serious adverse event in the 2 studies (139 children) followed up at 3 to 4 weeks
Health‐related quality of life	See comment	See comment	Not estimable	‐	See comment	This outcome was not reported
Cast changes and number of outpatient visits (3 to 6 weeks follow‐up)	See comment	See comment	Not estimable	‐	See comment	Data not provided. 3 studies (181 children) reported on treatment failure (treatment change or extended use due to delayed union)i
*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.