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Treatment of torus fractures in the forearm in children using bandage therapy
Claudia M Vernooij1, Marleen E Vreeburg, Michiel J M Segers
1Department of Emergency Medicine, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
Insights
Soft bandage therapy (BT) is a safe and effective treatment for pediatric torus forearm fractures, showing no increased risk of angulation and comparable pain scores to cast therapy. Minimizing misdiagnosis is crucial for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
Background:
- Torus fractures exhibit greater intrinsic stability than greenstick fractures due to an intact cortex.
- Previous studies indicated the safety and efficacy of soft bandage therapy (BT) for pediatric torus forearm fractures compared to cast therapy.
Purpose of the Study:
- To validate previous findings on the safety and efficacy of BT for torus forearm fractures.
- To assess complication rates and pain scores associated with BT in pediatric patients.
Main Methods:
- A single-center study included pediatric patients with torus fractures treated with BT from January to June 2009.
- The primary endpoint was secondary angulation, with pain assessed via Visual Analog Score (VAS).
Main Results:
- 49 patients with torus fractures were analyzed; no fracture displacement occurred.
- Four patients required additional pain management (NSAIDs or plaster cast).
- The overall VAS pain scores were lower than reported in prior studies.
Conclusions:
- Soft BT is a safe treatment for pediatric torus forearm fractures, posing no risk of further angulation.
- BT offers pain scores comparable to cast therapy.
- Minimizing misdiagnosis of torus fractures at initial presentation is essential.
Background:
In a torus fracture, there is an intact cortex at the side of the fracture which gives more intrinsic stability than in greenstick fractures, where one side of the cortex is disrupted. Two previously done studies compared soft bandage therapy (BT) with cast therapy in the treatment of torus forearm fractures in children and showed this is safe and does not cause any complications. The aim of our study was to validate these studies by treating all patients presenting to emergency department with a torus fracture with BT and investigate whether any complications occur.
Methods:
At a single-center from January 2009 to June 2009, all patients with an impacted greenstick fracture of the distal radius and/or ulna without exception were treated using BT. Primary endpoint was secondary angulation; secondary endpoint was pain on Visual Analog Score.
Results:
Seven patients were misdiagnosed as torus fractures but were actually greenstick fractures and had to be excluded. A total of 49 patients with a torus fracture were included in statistical analysis. No fracture displacement was seen. Four patients needed an additional nonsteroidal antiinflammatory drug or an antalgic plaster cast. The overall Visual Analog Score of the patients was lower than in previous studies.
Conclusions:
Soft BT is safe in all children without risk of further angulation and with a pain score equal to cast therapy. Important is that misdiagnosis of the torus fracture at initial presentation should be minimized.
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Assessment:
1. Clinical Evaluation:
History: