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Summary of recent advances in management of torus fracture of the distal radius in children
  1. Maysoon Hussain1,
  2. Dan Perry2,3,
  3. Shrouk Messahel3
  1. 1Ross University School of Medicine, Miramar, Florida, USA
  2. 2Trauma and Orthopaedics, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
  3. 3Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
  1. Correspondence to Dr Shrouk Messahel, Emergency Department, Alder Hey Children's Hospital, Liverpool, Merseyside, UK; Shrouk.Messahel{at}alderhey.nhs.uk

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Torus fractures of the distal radius are a common reason why children present to emergency department (EDs) and account for an estimated 500 000 ED attendances per year in the UK.1 Torus fractures account for up to 50% of all paediatric forearm fractures.2 They occur in skeletally immature children when the radius and/or ulnar experience a force resulting in bone compression rather than disruption, typically following a fall onto an outstretched hand. They have an excellent prognosis and heal well regardless of how, or even if, they are immobilised and have a very low risk of complications or deformity.3 Typically, diagnosis requires two plain film radiographs in the anteroposterior and lateral views of the distal forearm.

Recent improved understanding of the trajectory of pain and healing in torus fractures of the distal radius have challenged the dogma of the need of rigid immobilisation.2 The FORCE study (the FOrearm fracture Recovery in Children Evaluation study)3 was conducted in EDs across 23 UK sites, randomising 965 children with torus fractures of the distal radius. Children were randomised to receive either rigid wrist immobilisation (removable hard splints or plaster casts) or were not immobilised and offered a simple bandage worn at the discretion of the family. The study showed that the offer (with or without application) of a simple bandage was associated equivalence in self-reported pain and no difference in other outcomes including function, quality of life, complications and school absences. The study website4 contains clinician-based information for implementation and patient-based information to assist with the changes in clinical pathways. The impact of these measures has yet to be determined in …

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Footnotes

  • Twitter @shroukmessahel

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.