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ABSTRACT
BACKGROUND: Torus fractures of the distal radius are common; recommendations for management are diverse. The investigators conducted a survey of orthopedic surgeons to determine typical management of these fractures. The authors also conducted a randomized trial to compare treatment with either plaster casting or immobilization splinting.
POPULATION STUDIED: First, the investigators surveyed 104 pediatric orthopedic surgeons in Great Britain. Second, they conducted a randomized prospective study of 201 children aged 2 to15 years with distal radius torus fractures. A total of 22 patients was lost to follow-up, 4 in the cast group and 18 in the splint group, leaving 179 in the study.
STUDY DESIGN AND VALIDITY: Three studies were included in this article. The postal questionnaire was sent to 104 pediatric orthopedic surgeons. The questionnaire determined the incidence of torus fractures and the typical method of treatment by the individual practitioners. Clinic verses emergency department (ED) evaluation was considered, as was the prevalence of subsequent visits with and without additional radiologic studies. Only 65 (62.5%) of the questionnaires were returned and analyzed.
OUTCOMES MEASURED: The postal questionnaire measured incidence and treatment approach for torus fractures of the distal radius. The prospective randomized trial measured clinical and radiographic outcomes for plaster casting versus splinting treatment. Additionally, compliance with treatment assignment was assessed. Cost-benefit analysis compared the total costs of plaster casting versus splinting.
RESULTS: The questionnaire revealed that each orthopedist treated 5.1 (SD ± 4.8) torus fractures each week. For treatment that occurred in the ED, 64 physicians used some form of casting for treatment and 1 used a splint. When treatment took place in the office, however, 60 (92.3%) physicians used some form of casting and 5 (7.7%) used wrist splints. The fractures were immobilized for a mean of 2.9 (SD ± 0.64) (1 to 4) weeks. Eleven (16.9%) consultants routinely x-rayed the site at the end of treatment.
This study showed that treating torus fractures of the distal radius with casting versus splinting has no clinical difference in outcome. Some cost saving seems to occur when torus fractures are treated with splinting rather than casting, since splinting obviates a follow-up visit for cast removal. After reading this study, we agree that Futura splinting of distal radial torus fracture for 3 weeks appears to be a reasonable alternative to casting. The absence of complications in both groups suggests that a follow-up visit and confirmatory radiologic imaging may not be necessary.
ABSTRACT
BACKGROUND: Torus fractures of the distal radius are common; recommendations for management are diverse. The investigators conducted a survey of orthopedic surgeons to determine typical management of these fractures. The authors also conducted a randomized trial to compare treatment with either plaster casting or immobilization splinting.
POPULATION STUDIED: First, the investigators surveyed 104 pediatric orthopedic surgeons in Great Britain. Second, they conducted a randomized prospective study of 201 children aged 2 to15 years with distal radius torus fractures. A total of 22 patients was lost to follow-up, 4 in the cast group and 18 in the splint group, leaving 179 in the study.
STUDY DESIGN AND VALIDITY: Three studies were included in this article. The postal questionnaire was sent to 104 pediatric orthopedic surgeons. The questionnaire determined the incidence of torus fractures and the typical method of treatment by the individual practitioners. Clinic verses emergency department (ED) evaluation was considered, as was the prevalence of subsequent visits with and without additional radiologic studies. Only 65 (62.5%) of the questionnaires were returned and analyzed.
OUTCOMES MEASURED: The postal questionnaire measured incidence and treatment approach for torus fractures of the distal radius. The prospective randomized trial measured clinical and radiographic outcomes for plaster casting versus splinting treatment. Additionally, compliance with treatment assignment was assessed. Cost-benefit analysis compared the total costs of plaster casting versus splinting.
RESULTS: The questionnaire revealed that each orthopedist treated 5.1 (SD ± 4.8) torus fractures each week. For treatment that occurred in the ED, 64 physicians used some form of casting for treatment and 1 used a splint. When treatment took place in the office, however, 60 (92.3%) physicians used some form of casting and 5 (7.7%) used wrist splints. The fractures were immobilized for a mean of 2.9 (SD ± 0.64) (1 to 4) weeks. Eleven (16.9%) consultants routinely x-rayed the site at the end of treatment.
This study showed that treating torus fractures of the distal radius with casting versus splinting has no clinical difference in outcome. Some cost saving seems to occur when torus fractures are treated with splinting rather than casting, since splinting obviates a follow-up visit for cast removal. After reading this study, we agree that Futura splinting of distal radial torus fracture for 3 weeks appears to be a reasonable alternative to casting. The absence of complications in both groups suggests that a follow-up visit and confirmatory radiologic imaging may not be necessary.
ABSTRACT
BACKGROUND: Torus fractures of the distal radius are common; recommendations for management are diverse. The investigators conducted a survey of orthopedic surgeons to determine typical management of these fractures. The authors also conducted a randomized trial to compare treatment with either plaster casting or immobilization splinting.
POPULATION STUDIED: First, the investigators surveyed 104 pediatric orthopedic surgeons in Great Britain. Second, they conducted a randomized prospective study of 201 children aged 2 to15 years with distal radius torus fractures. A total of 22 patients was lost to follow-up, 4 in the cast group and 18 in the splint group, leaving 179 in the study.
STUDY DESIGN AND VALIDITY: Three studies were included in this article. The postal questionnaire was sent to 104 pediatric orthopedic surgeons. The questionnaire determined the incidence of torus fractures and the typical method of treatment by the individual practitioners. Clinic verses emergency department (ED) evaluation was considered, as was the prevalence of subsequent visits with and without additional radiologic studies. Only 65 (62.5%) of the questionnaires were returned and analyzed.
OUTCOMES MEASURED: The postal questionnaire measured incidence and treatment approach for torus fractures of the distal radius. The prospective randomized trial measured clinical and radiographic outcomes for plaster casting versus splinting treatment. Additionally, compliance with treatment assignment was assessed. Cost-benefit analysis compared the total costs of plaster casting versus splinting.
RESULTS: The questionnaire revealed that each orthopedist treated 5.1 (SD ± 4.8) torus fractures each week. For treatment that occurred in the ED, 64 physicians used some form of casting for treatment and 1 used a splint. When treatment took place in the office, however, 60 (92.3%) physicians used some form of casting and 5 (7.7%) used wrist splints. The fractures were immobilized for a mean of 2.9 (SD ± 0.64) (1 to 4) weeks. Eleven (16.9%) consultants routinely x-rayed the site at the end of treatment.
This study showed that treating torus fractures of the distal radius with casting versus splinting has no clinical difference in outcome. Some cost saving seems to occur when torus fractures are treated with splinting rather than casting, since splinting obviates a follow-up visit for cast removal. After reading this study, we agree that Futura splinting of distal radial torus fracture for 3 weeks appears to be a reasonable alternative to casting. The absence of complications in both groups suggests that a follow-up visit and confirmatory radiologic imaging may not be necessary.