Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study

Abstract

Objective The management and the diagnostic modalities used in cases of undisplaced greenstick and torus fractures of the distal radius in children vary between different treatment centres. The aim of this study was twofold: firstly, to analyse the sensitivity of X-rays versus ultrasound to diagnose these fractures; secondly, to compare three available treatment options (plaster cast, Futuro splints, and double Tubigrip) in terms of pain, analgesia requirements, grip strength, deformity, stiffness and interference with a child's activities of daily living. Methods We prospectively included 79 patients suffering from undisplaced greenstick and torus fractures of the distal radius. Patients were randomized (single blindly) to the studied treatment groups. Results In terms of diagnosis, the ultrasound was found to be more sensitive than X-rays for diagnosing these fractures. Our results also showed that Tubigrip was superior in terms of interference with a child's ADLs, stiffness and grip strength. However, there was no difference in the levels of pain, analgesia required, and deformity.Conclusion These results support the idea that ultrasound is an effective and sensitive tool for detecting undisplaced greenstick and torus fractures of the distal radius in children. Treating these fractures with functional nonrigid devices (Tubigrip) results in improved function without increased discomfort or deformity.

Point‐of‐care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient‐centered Outcomes

“…In their systematic review, Joshi et al found that most diagnostic errors involved the ends of long bones (physis, epiphysis, and metaphysis), suggesting a target that POCUS education should emphasize. Consistent with our work, a few studies have included anecdotal descriptions of cases where buckle fractures were detected on POCUS but missed on plain radiography . No studies to date have been sufficiently powered to compare the diagnostic accuracy of the x‐ray interpretation to POCUS for detection of extremity fractures based on a noninferiority hypothesis.…”

“…No studies to date have been sufficiently powered to compare the diagnostic accuracy of the x‐ray interpretation to POCUS for detection of extremity fractures based on a noninferiority hypothesis. However, these reports and others suggest that POCUS may be superior to plain radiography for detecting subtle injuries such as buckle fractures, Salter Harris type I fractures, and scaphoid fractures . Despite these reports, we suggest a judicious approach to the exclusive use of POCUS for diagnosis of forearm fractures in children.…”

“…The test performance characteristics of POCUS in our study are in line with a systematic review of eight studies in patients with extremity fractures that concluded that POCUS was an “accurate diagnostic test to rule in or rule out extremity fractures.” More specifically, sensitivity and specificity of POCUS for pediatric distal forearm fractures range from 71% to 100% and 73% to 91%, respectively . Sensitivity and specificity across studies that included children with buckle fractures ranged from 78% to 100% and 93% to 100%, respectively . This wide range may be due to the differences in the degree of experience of the ultrasonographers and the inclusion of children with angulated injuries in a number of studies .…”

Soft bandage versus casting in the treatment of torus fracture of distal radius in children; a prospective randomized study

“…In soft bandage group, 52 (91.22%) parents were convenient regarding the form of treatment and 5 (8.77%) were not whereas 36 (63.15 %) patients were convenient and 21(36.84%) patients were not convenient in B\E cast group. 2,[16][17][18][19][20] This study is based on the original study done by West S et al 2 who also compared the soft bandage with B\E cast for the treatment of isolated distal radius torus fracture. The results obtained by this work are nearly similar to that of original study and are statistically significant.…”

Indikationen zur sonographischen Frakturdiagnostik von Frakturen im Wachstumsalter

“…Erst in den letzten Jahren jedoch erlaubte der strukturierte Vergleich mit der Röntgendiagnostik [3,4,7,8,10,11,[19][20][21] die Entwicklung suffizienter Algorithmen und damit die Möglichkeit der flächendeckenden Anwendung. Mit der Sonographie lassen sich bei gleicher diagnostischer Qualität im Vergleich zum Röntgenbild die Abläufe erheblich beschleunigen und die Kosten senken [18].…”