Torus or buckle fractures are one of the most common skeletal injuries in skeletally immature individuals. These involve compression failure in the transitional zone between woven metaphyseal and lamellar diaphyseal bone. This injury is regarded as benign and common treatment involves simple immobilization for three to four weeks.
This study evaluated 201 patients with torus fracture in a prospective fashion. The children were randomized into two treatment protocols.. Eighty-five had a cast applied and 116 a Futura splint. Four cast and 18 splint patients failed to return for follow-up. All fractures followed united without loss of position or complication. The authors report a considerable cost saving using a simple splint compared to circumferential cast immobilization. In addition, the splint could be removed for bathing.
This study recommends a simple treatment paradigm using a short-arm splint for torus fractures of the distal radius. After initial ER or primary care evaluation, an upper extremity physician should confirm the diagnosis. The authors fail to stress the necessity of evaluation of the distal radioulnar joint. Pain-free forearm rotation differentiates a torus fracture from a pediatric Galeazzi variant, which is not amenable to short arm splint immobilization. This rarer injury should be included in the differential diagnosis.
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Journal of Bone and Joint Surgery