Clinical Question

Do Torus fractures need immobilisation and follow up or can they be discharged immediately with an optional bandage?

Title of Paper

Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK

Journal and Year

Lancet. 2022.

Lead Author

Dan Perry

Background

• Buckle/Torus fractures are really common. I see them all the time in our mixed department and I even had one recently in one of the couple of kids a day that make it into our adult-only department.
• They are minor injuries, with pain being the main clinical feature.
• Despite how common, and how minor they are, there is a lot of practice variation nationally and internationally on whether these need to be immobilised and whether or not they need formal follow up.
• A cochrane review concluded that recovery appeared similar regardless of approach, but that the evidence quality was low or very low leading to some uncertainty.
• It’s pretty common for parents to expect that “fracture” (”or is it a break?”) = “plaster”

Study Design

• Multicentre, randomised, controlled, equivalence trial (aiming to prove the intervention is neither better, nor worse than the comparator)

Patients Studied

• Children aged 4-15 with torus fractures
• Exclusions:
  • Injuries >36h old
  • Cortical disruption (greenstick)
  • Additional fractures outside the wrist