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Fracture Apparatus Design and Protocol Optimization for Closed-stabilized Fractures in Rodents

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Buckling down on torus fractures: has evolving evidence affected practice?

B A Williams¹, C A Alvarado², D C Montoya-Williams³

¹Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA.

Journal of Children'S Orthopaedics

|May 1, 2018

Summary

Paediatric torus fractures of the distal forearm are often managed with casts, despite evidence supporting splint immobilization. Splint-only treatment leads to fewer visits and X-rays, with similar outcomes.

Keywords:

Buckle fracture closed management evidence-based medicine wrist fracture

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Area of Science:

Orthopedic surgery
Pediatric orthopedics

Background:

Paediatric torus fractures of the distal forearm are common injuries.
Evidence suggests a 'minimalist' approach with splint immobilization and limited follow-up is effective.
Traditional cast-based management may persist despite alternative evidence.

Purpose of the Study:

To evaluate current management practices for paediatric torus fractures of the distal forearm.
To determine if a 'minimalist' splint-based approach is being adopted.
To test the hypothesis that traditional cast management persists.

Main Methods:

Retrospective review of paediatric patients with torus fractures (2011-2014).
Analysis of immobilization type (splint vs. cast), radiographic exams, immobilization duration, clinical visits, and complications.
Comparison of outcomes between cast group (CG) and splint group (SG).

Main Results:

16.7% of 240 injuries were exclusively splinted (SG).
The splint group (SG) had significantly fewer clinical visits, radiographic exams, and shorter total encounter time compared to the cast group (CG).
No significant difference in complications or clinically significant displacements between groups.

Conclusions:

Cast utilization and frequent radiographic follow-up remain prevalent for paediatric torus fractures.
Splint-only management is associated with reduced healthcare resource utilization.
A 'minimalist' splint approach offers comparable safety and efficacy with fewer patient and healthcare burdens.