![]() fibreglass/plaster of Paris), soft casts, removable splints and bandaging. 1 The interventions considered as part of this review were non-removable rigid casts (i.e. The recent NICE non-complex fracture guidelines made recommendations on the management of these injuries. 7, 9 Two systematic reviews support the abandonment of non-removable rigid casts in favour of splints removable at home. However, there is growing evidence to support the absence of complications with growing acceptance that rigid immobilization may not improve pain control but will unduly restrict function, and that patients may safely be discharged at diagnosis. cast/splint) argue that this maximizes pain relief, and minimises the occurrence of complications, i.e. 4- 8 The proponents of rigid forms of immobilization (i.e. The variation in practice has arisen from a longstanding taught doctrine of rigid immobilization for fractures, 3 tempered with newer evidence to suggest that simpler treatment methods are frequently as effective or perhaps even more effective. Treatment varies from the use of a removable rigid splint, to plaster cast immobilization, to more flexible splints. There is considerable variation in the management of torus fractures. They are very low risk injuries for complications or deformity in the skeletally immature, and these fractures universally heal well. They result from trauma to growing bones and account for 500,000 UK emergency attendances annually. Torus (buckle) fractures of the distal radius are the most common fractures in children, with the bone ‘buckling’, so there is deformation without a break in the cortex. It will not be possible to blind patients and care givers to their allocated treatment. All data will be obtained through electronic questionnaires completed by the participants and/or parents/guardian.Ĭite this article: Bone Joint Open 2020 1-6:214–221. The primary outcome is the Wong-Baker FACES pain scale at three days post-randomization. Three and six weeks after injury, the main outcomes plus data on complications, resource use, and school absence will be collected. ResultsĪt day one, three, and seven, data on pain, function, QoL, immobilization, and analgesia will be collected. Each patient will be randomly allocated (1:1, stratified by centre and age group (four to seven years and ≥ eight years) to either a regimen of the offer of a soft bandage and immediate discharge or rigid immobilization and follow-up as per the protocol of the treating centre. Baseline pain as measured by the Wong Baker FACES pain scale, function using the Patient-Reported Outcomes Measurement Information System (PROMIS) upper limb, and quality of life (QoL) assessed with the EuroQol EQ-5D-Y will be collected. MethodsĬhildren aged four to 15-years-old inclusive who have sustained a torus/buckle fracture of the distal radius with/without an injury to the ulna are eligible to take part. This is the protocol for a randomized controlled equivalence trial of ‘the offer of a soft bandage and immediate discharge’ versus ‘rigid immobilization and follow-up as per the protocol of the treating centre’ in the treatment of torus fractures. UK treatment varies widely due to lack of scientific evidence. Torus fractures are the most common childhood fracture, accounting for 500,000 UK emergency attendances per year.
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