Management of Torus Fractures of the Distal Radius and Ulna
Torus fractures of the distal radius and ulna should be managed with removable splinting (such as a soft bandage or removable wrist splint) for 3 weeks, with immediate discharge and no routine follow-up required. 1, 2, 3, 4
Immobilization Method
Use non-rigid, removable immobilization rather than rigid casting. The evidence strongly supports this approach:
- Removable splints or elastic bandages are superior to rigid casts for torus fractures 2, 5, 4
- Patients treated with removable splinting have:
Duration: 3 weeks of immobilization is sufficient 4. These fractures are inherently stable with minimal risk of displacement.
Follow-Up Protocol
No routine clinical or radiological follow-up is necessary 1, 3, 4. This represents a significant departure from traditional practice but is supported by high-quality evidence:
- Torus fractures are stable injuries that do not require monitoring for displacement
- Routine follow-up appointments and repeat radiographs add no clinical benefit
- Patients should receive adequate written information at initial presentation explaining the injury, expected healing timeline, and warning signs
Key Clinical Considerations
Provide clear discharge instructions including:
- Expected healing occurs within 3-4 weeks
- Return precautions: increasing pain, numbness, tingling, or inability to move fingers
- Instructions for active finger range of motion exercises to prevent stiffness 6
- Reassurance about the stability of the fracture
Common Pitfalls to Avoid
Over-treatment with rigid casting: Despite level 1 evidence, casting remains prevalent (71% in recent studies) 5, particularly among non-orthopedic providers. This leads to unnecessary complications and costs.
Unnecessary follow-up: Historical practice patterns persist, with 38-58% of patients receiving unnecessary fracture clinic appointments 1. This wastes healthcare resources without improving outcomes.
Finger stiffness: The most functionally disabling complication of distal radius fractures is finger stiffness 6. Instruct patients immediately to perform active finger motion exercises throughout treatment - this is cost-effective and prevents long-term disability.
Provider variation: Physician assistants and orthopedic residents show higher rates of casting 5, highlighting the need for standardized protocols across all provider types.
Concomitant Ulnar Fractures
When a torus fracture of the distal ulna accompanies the radius fracture (present in approximately 42% of cases 5), the same management approach applies - removable splinting for 3 weeks without routine follow-up. The presence of an ulnar fracture does not change the treatment algorithm for stable torus fractures.
Cost and Resource Implications
The material cost of splinting is approximately 10 times lower than casting 2, with overall healthcare costs reduced by nearly $1,400 per patient 5. Additionally, fewer clinic visits, fewer radiographs (2.76 vs 3.33 per patient), and reduced complication management represent substantial system-level savings.