Initial Treatment for Torus Fractures in Children
For torus (buckle) fractures of the distal radius in children, use a removable splint or soft bandage with immediate discharge—no cast, no follow-up, and no repeat imaging required. 1, 2
Immobilization Method
- Apply a removable splint or soft bandage for 3 weeks as the optimal treatment approach 1, 2
- Rigid circumferential casting is no longer recommended as first-line treatment, as it offers no clinical advantage over nonrigid immobilization 3
- Soft bandaging provides equivalent pain control at 3 days compared to rigid immobilization (pain scores 3.21 vs 3.14 on Wong-Baker FACES scale, with equivalence demonstrated within a margin of 1.0 point) 2
- Nonrigid immobilization methods demonstrate superior functional recovery, lower complication rates (relative risk 3.02,95% CI 1.70-5.37), and reduced treatment costs compared to rigid casting 3
Follow-Up Protocol
- Discharge the patient immediately from the emergency department with no scheduled fracture clinic follow-up 1
- No repeat radiological imaging is necessary once the diagnosis is confirmed on initial radiographs 1
- Provide adequate written information to parents/caregivers at the time of diagnosis to ensure they understand the benign nature of this injury 1
Duration of Immobilization
- Maintain immobilization for 3 weeks total 1
- The removable nature of the splint allows for hygiene and comfort while still providing adequate protection 2
Important Clinical Caveats
- Ensure accurate diagnosis: Confirm this is truly a torus fracture (cortical buckling without complete cortical disruption) and not a displaced or complete fracture requiring different management 1
- Patients with initial pain scores >50 mm on visual analogue scale may experience longer duration of pain regardless of immobilization method, but this does not change treatment recommendations 4
- Volar slabs may be associated with slightly longer duration of pain (median 6.0 vs 3.0 days) and delayed return to normal activity compared to circumferential casts, but soft bandaging remains the preferred option given overall equivalence and practical advantages 4
- This simplified treatment approach represents significant resource savings for patients, families, and healthcare systems without compromising outcomes 1
What to Avoid
- Do not apply circumferential plaster or fiberglass casts as they provide no clinical benefit and increase complications 3
- Do not schedule routine follow-up appointments as they are unnecessary and waste resources 1
- Do not obtain repeat radiographs unless new symptoms develop suggesting a different injury 1