Splinting versus casting of “torus” fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): A literature review

Firmin, Fiona; Crouch, Robert

doi:10.1016/j.ienj.2009.03.006

Cited by 37 publications

(47 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The diagnosis is established mainly by the clinical findings and confirmed by plain X-rays [6]. The treatment most commonly offered includes immobilization for a short period of time in plaster-of-Paris, either a backslab or a full cast [3,7]. Alternative treatment includes immobilization with a Futuro wrist splint [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Pountos

Clegg

Siddiqui

2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Alternative treatment includes immobilization with a Futuro wrist splint [3]. Follow-up arrangements may or may not be made, with some centres performing further X-rays [1,4,7,12]. These fractures are usually stable and heal without difficulty [11].…”

Section: Introductionmentioning

confidence: 99%

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

Pountos

Clegg

Siddiqui

2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…22 The present study's findings support the premise that PCP care represents a safe and feasible follow-up option for this low-risk fracture. Despite previous reports that parents 5 …”

Section: Discussionmentioning

confidence: 83%

“…2 As a result, extensive evidence recommends their treatment with a removable wrist splint, rather than the traditional use of casting. [2][3][4][5][6][7][8] After the initial diagnosis and treatment, most of these fractures are managed by orthopedic surgeons. 9 Given that intervention by an orthopedic specialist is rarely required for these fractures, it may also be appropriate to have these low-risk injuries followed up by the primary care provider (PCP).…”

mentioning

confidence: 99%

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

Koelink

Schuh²,

Howard³

et al. 2016

Pediatrics

View full text Add to dashboard Cite

OBJECTIVES: Our main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.METHODS: This prospective cohort study was conducted at a tertiary care pediatric emergency department (ED). Eligible children were aged 2 to 17 years with a distal radius buckle fracture treated with a removable splint and referred to the PCP for reassessment. We telephoned families 28 days after their ED visit. The primary outcome was the proportion who received PCP follow-up exclusively. We also measured the proportion who received PCP anticipatory guidance and those children who reported returning to usual activities "always" by 4 weeks. RESULTS:We enrolled 200 children, and 180 (90.0%) received telephone follow-up. Of these, 157 (87.2% [95% confidence interval: 82.3 to 92.1]) received PCP follow-up exclusively. Specifically, 11 (6.1%) families opted out of physician follow-up, 5 (2.8%) self-referred to an ED, and the PCP requested specialty consultation in 7 (3.9%) cases. Of the 164 with a PCP visit, 77 (47.0%) parents received anticipatory guidance on return to activities for their child, and 162 (98.8%) reported return to usual activities within 4 weeks. CONCLUSIONS:The vast majority of children with distal radius buckle fractures presented to the PCP for follow-up and did not receive additional orthopedic surgeon or ED consultations. Despite a suboptimal rate of PCP advice on return to activities, almost all parents reported full return to usual activities within 4 weeks.

show abstract

“…Radiographs fractures are inherently stable and the risk of displacement is very low or non-existent [3][4][5][6][7] . In a review of nine studies on torus fractures [3,[6][7][8][9][10][11][12][13] , May and Grayson (2009) found that in none of the studies was there loss of position, lack of recovery, need for orthopaedic intervention or ongoing pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of splint and conventional cast for treating wrist torus fractures in children (systematic review)

Alsawadi¹,

Abbas²

2017

Adv Emerg Med

View full text Add to dashboard Cite

Wrist torus fractures in children are common. Although it might be simple and straightforward, the management of these injuries remains controversial and depends on the personal experience and preference of the treating physician. The consensus agreement, however, is that these fractures are inherently stable. Some authors argue that splints should replace the traditional method of cast immobilisation. The splints are viewed as easier to use, more convenient and do not require follow up clinics for removal. It has also been argued that splints are more cost-effective than casts. The aim of this systematic review is to examine the effectiveness and cost-effectiveness of removable splints versus casts in the treatment of torus wrist fractures of children in the current literature. This review followed the Systematic reviews and Meta-Analyses (PRISMA) statement for reporting. Comprehensive electronic database search and handsearch were conducted. Studies were considered for review if they were randomised or quasi-randomised controlled trial and compared removable splints and casts for treating torus fractures of distal radius and/or ulna in children. Four papers identified by two reviewers as potentially eligible for inclusion were appraised and two identified for inclusion were further assessed for any risk of bias. Data were narratively presented and discussed as meta-analysis would not have been possible for the identified studies. The limited available data favours the use of splint as a clinically effective and more cost-effective method of immobilisation. However, the findings of the systematic review are limited by the quality of the identified studies. It has been viewed that explanation to patients and parents and involving them in the decision, plus implementation of safety protocol to avoid under-treatment of misdiagnosed fractures and allow easy access of patients to the clinic, is an alternative way to provide safe, convenient and cost-effective treatment.

show abstract

Splinting versus casting of “torus” fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): A literature review

Cited by 37 publications

References 14 publications

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

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

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

Comparison of splint and conventional cast for treating wrist torus fractures in children (systematic review)

Contact Info

Product

Resources

About