Faris Ali, N Jayakumar, I Mubark, A Nagi and C Kitsis
Queen’s Hospital, UK
Posters & Accepted Abstracts: J Cancer Sci Ther
Statement of the problem: Buckle fractures also known as torus fractures are commonly caused by a fall on the
outstretched hand and are most often seen in the paediatric population. The mechanism of injury leads to compression
and subsequent buckling of the dorsal cortex but the volar cortex is usually unaffected. NICE (NG38) recommend
that children with torus forearm fractures should not have rigid casts and should be discharged from hospital after
assessment and reassurance. Our initial audit reviewed the practice in our unit between August-October 2017 and
it showed that 95% of patients were treated with a cast and 86.2% attended for a follow-up visit. Following this,
recommendations were made including education regarding management as per NICE guideline with application
of wrist splints in the Emergency Department (ED) or Fracture Clinic and discharging the children after providing
carers with information leaflets and reassurance.
Methodology & Theoretical Orientation: Retrospective audit of all buckle fractures referred to the Fracture Clinic
between Julyâ??September 2018 (inclusive). Clinic letters and images reviewed using MediSec and PACS, respectively.
Findings: Thirty-six patients were included (63% male; mean age 9 years). In ED, 19% of patients were given a splint
compared to 0%. In fracture clinic, 54% were given a splint and of those only 38.9% were discharged at first visit. A
further 55.6% of patients were brought back for a second visit. Four patients were given a cast due to size issues or
patient preferences.
Conclusion & Significance: Despite the improvement seen regarding compliance with NICE guidelines, work is
needed to further enhance compliance. Staff education and optimising splint availability will be a priority to reduce
the burden on fracture clinic resources by unnecessary follow-up appointments.
Recent Publications
1. Hill C E, Masters J P and Perry DC (2016) A systematic review of alternative splinting versus complete plaster
casts for the management of childhood buckle fractures of the wrist. J Pediatr. Orthop. B. 25(2):183-90.
2. Jiang N, Cao Z H, Ma Y F, Lin Z and Yu B (2016) Management of Pediatric Forearm Torus Fractures: A
Systematic Review and Meta-Analysis. Pediatr. Emerg. Care. 32 (11):773-778.
3. National Institute for Health and Care Excellence. (2016). Fractures (non-complex): assessment and
management (NICE Guideline NG38). Retrieved from https://www.nice.org.uk/guidance/ng38
4. Firmin F, Crouch R. Splinting versus casting of "torus" fractures to the distal radius in the paediatric patient
presenting at the emergency department (ED): a literature review. 2009. In: Database of Abstracts of Reviews of
Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK);
1995-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK77692/
5. B.A. Williams, C.A. Alvarado, D.C. Montoya-Williams, R.C. Matthias, L.C. Blakemore. Buckling down on
the torus fracture: has evolving evidence affected practice ?https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC5902745/
Dr Faris is a foundation year Doctor with passion for Orthopaedics. He is currently working under the Trauma & Orthopaedic’s team in Queen’s Hospital Burton, UK. The whole team of authors from our unit endeavour to improve the quality of patient care and improve efficiency.
E-mail: farisali93@hotmail.com
Cancer Science & Therapy received 3968 citations as per Google Scholar report