Management of Acute Torus Fracture of Distal Posterior Radial Diaphysis
The initial management for an acute torus (buckle) fracture of the distal posterior radial diaphysis with mild posterior angulation should be a removable splint worn for 3 weeks without the need for fracture clinic follow-up or repeat radiological imaging. 1
Diagnosis Confirmation
- Standard radiographs are the initial imaging of choice to confirm the diagnosis and rule out associated fractures 2
- In equivocal cases, CT without IV contrast can better visualize fracture morphology 2
- Ultrasound may be useful for confirming diagnosis in some cases 2
Immobilization Protocol
Type of Immobilization
- Removable splint is preferred over traditional circumferential cast for torus fractures 1, 3
- The splint should be:
- Properly fitted to avoid compromising circulation
- Applied with the wrist in a functional position
- Removable to allow for hygiene and comfort
Duration of Immobilization
- Recommended immobilization period: 3 weeks 1, 3
- No need for fracture clinic follow-up once adequate information is provided at diagnosis 1
- No repeat radiological imaging is necessary if initial diagnosis is clear 1
Pain Management
- NSAIDs are recommended for pain and inflammation control 2
- Ice application during the first 3-5 days can provide symptomatic relief 2
- Oral analgesics can be used for residual pain as needed 2
Patient Education
- Instruct on proper splint use and care 2
- Educate about expected timeline for healing (typically 3-4 weeks)
- Advise on when to seek medical attention (if extremity appears blue, purple, or pale) 2
- Explain that torus fractures have excellent healing potential with minimal risk of complications
Rehabilitation
- After the immobilization period (3 weeks), begin progressive range of motion exercises 2
- Implement directed home exercise program to promote optimal recovery 2
- Full recovery is typically expected within 6-8 weeks 2
Special Considerations
For Children
- Children have higher tolerance for immobilization and faster healing rates, allowing for shorter immobilization periods 2
- Torus fractures are common in children and have excellent healing potential 4
For Adults
- In adults with torus fractures, the same principles apply, but closer monitoring may be warranted
- Consider evaluation for osteoporosis risk factors in older adults 2
Potential Complications
- Torus fractures generally have excellent outcomes with minimal complications 1, 3
- Predictive factors for displacement in distal radius fractures include patient age, original displacement, and intra-articular involvement 5, but these are less relevant for stable torus fractures
- The quality of cast molding (gap index) and wrist position during immobilization have not been shown to significantly affect outcomes in torus fractures 5
This evidence-based approach represents both an economical and resource-saving management strategy for patients and healthcare systems while maintaining excellent clinical outcomes.