The Role of Serial Radiographs in the Management of Pediatric Torus Fractures

Abstract

To assess the utility of radiographs taken immediately after the application of a cast in the management of pediatric torus (or buckle) fractures and to determine the need for serial radiographs taken at follow-up visits. Design: Retrospective medical record review; survey questionnaire of a panel of experts. Setting: The pediatric emergency department (PED) and the pediatric orthopedic clinic at an urban, tertiary care hospital. Patients: All children with torus fractures referred to the pediatric orthopedic clinic for follow-up visits between February 1995 and February 1997. Main Outcome Measures: The number of patients whose postcast studies was obtained in the PED; number of follow-up visits and studies conducted at the pediatric orthopedic clinic; usual regional practices as extracted from a panel of experts by survey questionnaire. Results: Of 70 patients, 46 (66%) were evaluated by a single, precast study in the PED, and 24 (34%) were evaluated by both precast and postcast studies in the PED. The time range of the first follow-up study was the first to fifth week after the patient's injury. The range of the number of follow-up studies for each patient was 0 to 5. Our cohort's total radiology charges for 70 patients were $27 251. Regional directors of pediatric orthopedic surgery unanimously agreed that postcast studies in the PED are unnecessary. The range of the number of follow-up studies they obtained is 0 to 3 per patient. Conclusions: Postcast studies of torus fractures are unnecessary. Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. Relying on the clinical examination, perhaps combined with a single follow-up study, is a more appropriate regimen for the management of pediatric torus fractures and translates into a cost savings of over $10 000 for our 70 patients.

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

“…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].…”

Primary Care Physician Follow-up of Distal Radius Buckle Fractures

“…Importantly, most of the patients who saw a PCP only required 1 visit, and very few had repeat imaging. This finding contrasts with the practice in some orthopedic clinics in which several visits and repeat radiographs seem to be common, 23,24 leading to increased health care costs, loss of patient and provider time, and exposure to potentially unnecessary radiation. 23 Approximately 10% of injuries diagnosed by the ED physician as distal radius buckle fractures were subtle examples of more complex injuries.…”

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

“…West et al (2005) recommended a future change in treatment policy for torus fractures, when their study found that each of their 39 patients who were randomly assigned to treatment with a cast or soft bandage splint reported no adverse effects, normal fracture healing and had a high degree of patient and parent satisfaction. Farbman et al (1999) retrospectively reviewed medical records over a two year period and assessed the need for follow-up visits in patients with torus fractures. Repeat radiographs were examined, which consequently confirmed no change in bony alignment at any torus fracture site, at any point in time after application of a cast.…”

“…Forearm fractures account for approximately 35-45% of all fractures seen in children and of these 85% involve the distal radius (Boyer et al, 2002). Wrist fractures are a common injury amongst children and many of these fractures are diagnosed as a buckle or torus fracture usually occurring in the distal radius (Farbman et al, 1999). Traditionally, treatment requires 2-4 weeks immobilisation in a below elbow short arm cast with orthopaedic follow up, but recent studies have considered looking at the alternative of removable splints.…”