From the Guidelines
A torus fracture of the distal radial metadiaphysis with mild soft tissue edema is best treated with immobilization using a removable splint or cast for 3-4 weeks, as recommended by the most recent and highest quality study 1. This type of fracture, also known as a buckle fracture, is stable and has an excellent prognosis without the need for reduction or surgery. Pain management should include acetaminophen (15 mg/kg every 4-6 hours, not exceeding 75 mg/kg/day or 4000 mg/day in adults) or ibuprofen (10 mg/kg every 6-8 hours with food, maximum 40 mg/kg/day or 3200 mg/day in adults) for the first few days, as suggested by the American Academy of Orthopaedic Surgeons 1. Elevation of the affected limb above heart level and application of ice for 15-20 minutes several times daily during the first 48 hours will help reduce swelling, as recommended by the EULAR/EFORT guidelines 1. Follow-up with an orthopedic specialist or primary care provider in 1-2 weeks is recommended to ensure proper healing, as stated in the American Academy of Orthopaedic Surgeons guidelines 1. These fractures typically heal completely within 4-6 weeks without complications because the periosteum remains intact on one side, providing stability and promoting rapid bone healing, especially in children where these fractures are most common. Some key points to consider in the management of torus fractures include:
- Early finger motion is essential to prevent edema and stiffness after casting or surgery for distal radius fracture, as recommended by the EULAR/EFORT guidelines 1
- Aggressive finger and hand motion is necessary to facilitate the best possible outcomes after immobilization is discontinued, as stated in the EULAR/EFORT guidelines 1
- Opioid alternatives, such as acetaminophen and ibuprofen, should be considered alongside opioid-sparing protocols when possible, as recommended by the American Academy of Orthopaedic Surgeons 1
- The use of supervised therapy programs, serial radiography, and pain control remains limited, and these represent opportunity areas for future investigation, as noted in the American Academy of Orthopaedic Surgeons guidelines 1.
From the Research
Diagnosis and Management of Acute Torus Fracture
- Acute torus fracture of the distal radial metadiaphysis with mild soft tissue edema can be diagnosed using plain radiographs of the wrist joint 2.
- The management of torus fractures involves immobilization, with studies suggesting the use of removable splints or soft-bandages for 3-4 weeks 3, 4, 2.
Immobilization Method and Duration
- Research indicates that torus fractures can be managed with a removable splint supplied in the emergency department and worn for 3 weeks 3.
- A study comparing traditional forearm plaster-of-Paris cast with a 'Futura-type' wrist splint found no difference in outcome between the two groups, with all patients having a good result 4.
Follow-up and Radiological Imaging
- There is no need for fracture clinic follow-up or repeat radiological imaging once patients are given adequate information at the time of diagnosis 3, 2.
- A simple treatment approach involving a wrist splint and review on the following day to confirm the diagnosis and give appropriate advice can be effective 4.
Soft-Tissue Injuries
- Soft-tissue injuries associated with distal radius fractures, including injuries to the skin, tendon, and muscle, ligaments, and neurovascular structures, may influence strategies for acute management 5.
- Mild soft tissue edema can be managed with immobilization and supportive care, with close monitoring for any signs of complications or worsening symptoms.
Special Considerations
- Torus fractures can occur in adults, although they are more common in children, and can be considered a new type of occult fracture in this population 6.
- Knowledge of this possibility is mandatory to make a differential diagnosis of wrist sprain in adults and avoid performing superfluous complementary tests due to persistence of pain and functional incapacity 6.