Originally published by 2 Minute Medicine^® (view original article). Reused on AccessMedicine with permission.

1. Difference in pain severity by day 3 of randomization was negligible between the soft bandage and rigid immobilization groups.

2. Both groups were comparable in terms of parental satisfaction, use of analgesia, and school absences at 6 weeks.

Evidence Rating Level: 1 (Excellent)

Study Rundown:

Torus (buckle) fractures are among the most prevalent of childhood fractures. Management of such fractures usually includes cast immobilization. However, given the quick recovery time, relative to osseous fractures in adults, some experts believe that use of less aggressive measures (i.e., soft bandage) may be adequate. This randomized controlled trial aimed to compare the effectiveness of soft bandage versus rigid wrist immobilization for management of torus fractures of the wrist in children. The primary outcome was severity of pain at 3 days from randomization, assessed using the Wong-Baker FACES Pain Rating Scale. Key secondary outcomes included parental satisfaction, use of analgesia, and school absence. According to study results, the soft bandage group and rigid immobilization group both reported similar pain levels at day 3 post-immobilization. On day one post-immobilization, there was a significantly increased use of analgesia in the soft bandage group, however, this did not persist after the first day. This study was limited through use of a subjective Pain Rating Scale which differs from one interpreter to next. As well, pain is a subjective marker and one that differs greatly from one individual to next.

Click to read the study in The Lancet

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In-depth [randomized-controlled trial]:

From Jan 16, 2019, and Jul 13, 2020, 1513 patients were assessed for eligibility across 23 hospitals in the UK. Included were children aged 4-15 years with a radiologically confirmed distal radius torus fracture. Altogether, 908 children (466 in bandage group and 476 in rigid immobilization group) were included in the intention-to-treat analysis. The soft bandage intervention consisted of gauze roller bandages while the rigid immobilization group received either a manufactured rigid wrist splint or a plaster-based splint molded by the clinicians. The primary outcome of pain at 3 days from randomization was comparable in both groups (3.21 out of 10, standard deviation [SD] 2.08 for bandage vs. 3.14 out of 10, SD 2.11 for rigid immobilization). Although parental satisfaction was initially higher in the rigid immobilization group, this difference was negligible by week 6. This was also the case for use of analgesia within 24 hours (83% bandage and 78% rigid, p=0.04 on day 1 vs. 25% bandage and 23% rigid, p=0.21 on day 7). The proportion of children with school absences did not differ between the soft bandage and rigid immobilization groups (26% vs. 22%, odds ratio [OR] 0.79, p=0.14). Findings from this study support the use of soft bandage as an alternative to rigid immobilization for distal radius torus fracture in children.

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