Velcro Wrist Splint vs. Cast for Torus Fracture

Short Attention Span Summary

What's the best way to treat a torus forearm fracture in kids?
This was a meta-analysis of 8 RCTs totaling 781 children with torus fractures of the forearm.  They found that non-rigid methods of immobilization, including "soft cast, splint, bandage, and slab," were superior to rigid casting in regard to "functional recovery, treatment cost, and complication rate."  And patients preferred non-rigid immobilization.

Spoon Feed
A simple volar slab or velcro wrist splint or "soft cast" was better than a rigid cast for pediatric torus fractures of the forearm.


Abstract

Pediatr Emerg Care. 2016 Nov;32(11):773-778.

Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis.

Jiang N1, Cao ZHMa YFLin ZYu B.

Author information:

1From the *Department of Orthopaedics and Traumatology, †Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou; ‡Department of Minimally Invasive Spine Surgery, Second Affiliated Hospital to Inner Mongolia Medical University, Hohhot; and §Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China.

Abstract

OBJECTIVES:

Pediatric forearm torus fracture, a frequent reason for emergency department visits, can be immobilized by both rigid cast and nonrigid methods. However, controversy still exists regarding the optimal treatment of the disease. The aim of this study was to compare, in a systematic review, clinical efficacy of rigid cast with nonrigid methods for immobilization of the pediatric forearm torus fractures.

METHODS:

Literature search was performed of PubMed and Cochrane Library by 2 independent reviewers to identify randomized controlled trials comparing rigid cast with nonrigid methods for pediatric forearm torus fractures from inception to December 31, 2013, without limitation of publication language. Trial quality was assessed using the modified Jadad scale.

RESULTS:

Eight randomized controlled trials with a total of 781 participants met all inclusion criteria. The nonrigid methods for immobilization included soft cast, splint, bandage, and slab. Results showed that nonrigid immobilizations had better clinical efficacy than rigid cast regarding functional recovery, treatment cost, and complication rate (relative risk, 3.02; 95% confidence interval, 1.70-5.37; P = 0.0002). Compared with rigid cast, more patients would like to choose the nonrigid methods of immobilization for future use. However, discrepant results sill surrounds the pain levels of the patients.

CONCLUSIONS:

The current study suggests that the nonrigid immobilization methods have more advantages than rigid cast for immobilization of pediatric forearm torus fracture. The former strategies are also safe enough for clinical therapy.

PMID: 26555307 [PubMed - in process]