What is the treatment for a pediatric patient with a torus fracture of the radius bone?

Treatment of Pediatric Torus Fracture of the Radius

Treat with a removable splint for 3 weeks, discharge from the emergency department with appropriate instructions, and do not schedule routine follow-up or repeat radiographs. 1, 2

Immobilization Method

• Use a removable splint (such as a Futura-type wrist splint) rather than a rigid cast for all nondisplaced torus fractures of the distal radius 1, 2
• Removable splints provide equivalent pain control and functional outcomes compared to rigid casting, with no difference in healing 3, 4
• The splint should be applied in the emergency department at the time of diagnosis 2, 4

Duration of Immobilization

• Immobilize for exactly 3 weeks, then discontinue the splint 1, 2, 4
• This duration is sufficient for adequate healing of stable torus fractures 2, 4

Follow-Up Protocol

• No routine clinical follow-up is necessary once adequate information is provided to parents at the time of diagnosis 2, 4
• No repeat radiographs are required if the initial diagnosis is confirmed and the fracture is truly nondisplaced 2, 4
• Consider next-day review only to confirm the diagnosis and provide appropriate advice, but further follow-up is not evidence-based 4

Immediate Rehabilitation

• Initiate active finger motion exercises immediately following diagnosis to prevent stiffness 1
• Finger motion does not adversely affect adequately stabilized distal radius fractures and prevents the most functionally disabling complication 1
• Early wrist motion is not necessary for stable fractures 1

When Surgical Management Is Indicated Instead

If any of the following radiographic parameters are present, this is NOT a simple torus fracture and requires different management:

• Displacement >3mm 1, 5
• Dorsal tilt >10° 1, 5
• Intra-articular involvement 1
• Any of these findings indicate the need for surgical fixation rather than conservative splinting 1, 5

Critical Pitfalls to Avoid

• Do not use rigid plaster casts – they provide no benefit over removable splints for torus fractures and increase cost and complications 2, 3, 4
• Do not schedule routine fracture clinic follow-up – this wastes healthcare resources without improving outcomes 2, 4
• Do not obtain repeat radiographs unless there is clinical concern for displacement or another injury 2, 4
• Do not delay finger exercises – stiffness is preventable and highly disabling 1

Parent Education at Discharge

Provide clear written and verbal instructions that:

• The splint should be worn for 3 weeks 2, 4
• Finger exercises should begin immediately 1
• Return only if severe pain develops, the splint cannot be tolerated, or new concerning symptoms arise 4
• No routine follow-up appointment is needed 2, 4

Cost and Resource Considerations

This simplified protocol represents significant economic and resource savings for patients, families, and the healthcare system by eliminating unnecessary clinic visits, radiographs, and cast applications 2, 4