![]() Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Ĭlinical Question: What is the appropriate management of torus fractures in children? It is a great example of how knowledge translation can take years or even decades for clinically relevant information to reach the patients’ bedside due to leaks in the EM knowledge translation pipeline. Yet here we are ten years later doing an SGEM episode on whether it is ok to put a soft bandage on these pediatric patients with a distal radius buckle fracture. An RCT published 12 years ago reported that a soft bandage wrapping treatment for four weeks was not statistically different for discomfort, function or fracture displacement compared a below elbow back slab cast for one week followed by circumferential cast for three weeks despite some more pain in the first week with the soft bandage. A survey done almost 20 years ago in Canada demonstrated the variability of managing buckle fractures by Pediatric orthopedic surgeons and pediatric emergency physicians. Some clinicians apply casts, some a splint, some have orthopedic follow up, some have no follow up. Despite being a common injury they are often managed differently. In contrast, a greenstick fractures the opposite cortex is not intact.īuckles of the distal radius are the most common fracture seen in children and very commonly present to the ED. Buckle fractures (also called torus fractures) are defined as a compression of the bony cortex on one side with the opposite cortex remains intact. In that episode from ten years ago we made the distinction between a buckle fracture and greenstick fractures. The X-ray shows a buckle fracture of his right distal radius.īackground: We covered buckle fractures way back in Season#1 of the SGEM on SGEM#19. He has bony tenderness at the distal radius. His right arm is neurovascularly intact, with no swelling or deformity. Today he was running at school, and he fell over onto his outstretched arm. Tessa also has a weekly newsletter with tips to help you level up your use of everyday technology and to optimise your writing and to reach the audience you want.Ĭase: Jack is nine years old, and he presents to emergency department (ED) with an arm injury. Tessa Davis is a Paediatric Emergency Consultant at the Royal London Hospital, Senior Lecturer at Queen Mary University of London, Co-founder of Don’t Forget The Bubbles ( DFTB). Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. West S, Andrews J, Bebbington A, et al.One brace: one visit: treatment of pediatric distal radius buckle fractures with a removable wrist brace and no follow-up visit. ![]() Increasing brace treatment for pediatric distal radius buckle fractures: using quality improvement methodology to implement evidence-based medicine. Little KJ, Godfrey J, Cornwall R, et al.American Medical Society for Sports Medicine.Parent satisfaction is also increased when these fractures are treated with a brace. Treating in a cast and repeating x-rays increases health care costs and radiation exposure for the patient. Radius buckle fractures can be safely treated with a Velcro removable wrist splint for three to four weeks, as long as the following conditions are met: 1) cortex is intact, 2) there are no fracture lines extending to the physis on any view, 3) there is no angulation or displacement of the fracture, 4) there are two or three inflection points seen in the cortex on either view that best represents the fracture, and 5) the parent can do a symptom check with instructions. These fractures are inherently stable and have an excellent prognosis. Distal radius buckle fractures are one of the most common wrist fractures in children.
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