Pediatric Torus Fracture – Best Immobilization

Written by Clay Smith

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Torus fractures of the distal radius in children may be treated with a removable splint, simple bandage, or no treatment at all, though parents may not feel as good about the last option.

Why does this matter?
In the UK, NICE guidelines recommend bandage or removable splint instead of rigid cast. These are very stable fractures. What does the best evidence tell us?

Buckle up…
This was a concise review of a topic about which there is uncertainty. A 2018 Cochrane review of 9 RCTs found that a bandage or splint vs rigid cast was not inferior. So, where is the uncertainty? All the RCTs were considered lower quality, as they were all unblinded, had high attrition, and small sample sizes. Overall, pain scores in these studies were similar with a splint or bandage vs cast, and no adverse events were noted. A larger trial is underway in the UK and is due to report out in late 2021, called the FORCE trial. In the meantime, parents don’t seem to like the alternative of “no treatment.” A soft bandage or splint tends to be better received. In my practice setting, we now use a removable velcro wrist splint for these children. It provides immobilization, seems to improve pain, and families seem to like that it can be removed to allow hand-washing and bathing.

What level of immobilisation is necessary for treatment of torus (buckle) fractures of the distal radius in children? BMJ. 2021 Jan 7;372:m4862. doi: 10.1136/bmj.m4862.

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