Management of Transverse Torus Fractures of Distal Radial and Ulnar Metaphyses
For transverse torus (buckle) fractures of the distal radial and ulnar metaphyses, a removable splint such as a DonJoy brace is sufficient and preferred over casting. 1, 2
Evidence-Based Treatment Approach
- Removable splints are recommended by the American Academy of Orthopaedic Surgeons (AAOS) as an appropriate treatment option for minimally displaced distal radius fractures, including torus/buckle fractures 1
- Rigid immobilization (casting) is unnecessary for stable buckle fractures and should be reserved for displaced fractures 2
- Management with removable splints represents economic and resource savings for healthcare systems compared to casting 2
- Current research indicates torus fractures should be managed with a removable splint worn for approximately 3 weeks 3
Clinical Decision Algorithm
When to Use a Removable Splint (DonJoy brace):
- For minimally displaced or non-displaced torus/buckle fractures 1
- When there is no significant angulation or displacement 1
- For stable fracture patterns 2
When to Consider Casting Instead:
- If there is significant displacement (>3mm) 1
- If there is dorsal tilt >10° 1
- If there is intra-articular involvement 1
- For unstable fracture patterns that require rigid immobilization 4
Duration and Follow-up
- Immobilization should typically last for approximately 3 weeks 1, 3
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
- For stable torus fractures, some evidence suggests there may be no need for fracture clinic follow-up or repeat radiological imaging once patients are given adequate information at diagnosis 3
Important Considerations
- Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of distal radius fractures 1
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
- Monitor for potential complications such as skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
- For combined distal radius and ulnar metaphyseal fractures, treatment of the ulnar component should be addressed after treating the distal radius fracture 5
Common Pitfalls to Avoid
- Overtreatment with casting for stable torus fractures, which can lead to unnecessary immobilization complications 2, 3
- Undertreatment of fractures with significant displacement or instability that actually require rigid immobilization 1
- Failure to recognize that fractures that re-displace in a properly applied cast likely represent unstable patterns that may require surgical fixation 6
- Overlooking the need for patient education regarding proper use of removable splints and the importance of compliance with wearing instructions 3