Paediatric wrist-buckle fractures are common distal radius fractures with inherent stability. Traditional management with complete plaster-cast immobilization necessitates follow-up visits, time off school/work and hospital treatment costs. Treatment with alternative splinting, negating the need for follow-up visits and saving time and money, has been proposed. However, concerns with regard to complications, primarily pain, have been raised; hence, the topic remains controversial. A systematic review was performed with eight randomized-controlled trials analysed. Alternative splinting was superior to casting in terms of function, cost and convenience, but with no significantly worse pain or fracture complication level. The evidence endorses the use alternative splinting over casting in paediatric wrist-buckle fractures.