Splinting versus casting of "torus" fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): a literature review.
OBJECTIVE
To compare outcomes regarding splinting versus casting of paediatric torus fractures in the ED with the aim of establishing the preferred treatment.


METHODS
Evidence was collated using electronic databases; Pubmed, Ovid, Medline and Cochrane library. Search terms included [torus fractures; buckle fractures; splinting distal radius fractures; paediatric wrist fractures; paediatric forearm fractures/injuries; cast versus splint]. Searches identified papers published between 1984 and June 2008.


RESULTS
The review demonstrated that children with removable splints preferred them to casts, in terms of improved physical functioning and lower pain scores reported after initial injury than those with casts. Children demonstrated this by using their wrists in the first week after injury to shower and bathe more easily. The cast group reported unscheduled visits to ED due to problems with the cast, such as discomfort or re-application of the cast from getting it wet. Using a splint will have considerable economic implications, money was found to be saved in terms of time and resource management. Radiographs taken at 4 weeks in both the cast and splint group confirmed that all fractures healed without significant change in alignment, suggesting that neither clinical nor radiographic follow-up is necessary for injury.


CONCLUSIONS
Torus splints in all the studies were consistently better than plaster immobilisation in terms of clinical outcome, patient preference and cost, with the exceptions of young children or children with special needs who can easily remove the device. Splinting torus fractures may reduce cost, time and resource management if used instead of casting in the ED.
Firmin
Fiona
F
Emergency Department, Southampton University, Hospital Trust, Tremona Road, Southampton Hampshire SO16 6YD, United Kingdom. fiona.firmin@hotmail.co.uk
Crouch
Robert
R
D001294:Attitude to Health; D002370:Casts, Surgical / Q000009:adverse effects / Q000191:economics; D002648:Child; D017046:Cost Savings; D004638:Emergency Treatment / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D055416:Evidence-Based Emergency Medicine; D006801:Humans; D010372:Pediatrics / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D002666:Psychology, Child; D011885:Radius Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012449:Safety; D013165:Splints / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014954:Wrist Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*