Distal radius fractures are common in children. The torus fracture implies a metaphyseal fracture, little deformity and moderate tenderness. A variety of measures have been used to treat these fractures. This retrospective study addressed the use of removable plaster of Paris volar forearm splint. Parents were instructed on a splint wearing schedule that was symptom based. Forty-eight patients were included in the study over a three-year period. Following accurate diagnosis, a volar forearm splint with plaster and cast padding was molded using elastic bandage. The parents were instructed to remove the splint for activity and to gradually diminish usage until the wrist was no longer tender to palpation or percussion. The parents were instructed to return in four to five weeks for clinical and x-ray evaluation.
Of the initial 48 patients, 9 were excluded as they were evaluated only after the fracture had already healed. In addition, 6 patients did not return to follow up. The patients reported using the splint for a mean of 2.8 weeks with a range from one to four weeks. Four weeks after fracture, all patients had resumed their regular activity. Some of the x-rays were lost at follow up but relatively little change occurred between the initial films and subsequent films. There were some significant differences but the x-rays, however, the differences were small and clinically insignificant. In addition, the small size of patients prohibited definitive statistical analysis.
This article presents evidence that a removable splint is appropriate for torus fractures. The physician must be sure that the fracture does not involve the distal radioulnar joint or represent a variant of pediatric Galeazzi fracture. Once the diagnosis is confirmed, symptomatic splinting is an appropriate technique in a reliable parent-child setting. Similar results were reported in the last edition of On-line Scholarly Review.
J Pediatr Orthop