Torus Fractures: Evidence from the FORCE study
Torus fractures (also called buckle fractures) of the wrist are the most common type of broken bone in children. They are also the mildest form of broken bone, in which the bone crushes (or buckles), instead of breaking.
FORCE dissemination video
Despite being so common, there is no ‘standard’ or ‘agreed’ treatment. Traditionally doctors have used plaster casts and arranged outpatient follow-up. However, medical research suggested that wearing a bandage, or even having no treatment, might be similarly good.
About the FORCE Study
The FORCE study looked into whether or not a bandage (which was optional to wear) and no further follow-up resulted in the same levels of pain and speed of recovery as a hard splint and usual follow-up.
A total of 965 children aged 4–15 years from 23 emergency departments in the UK took part in the study. Children were fairly divided between the bandage and hard splint groups in a process called randomisation. Prior to the study, families told us that managing pain after injury was the most important issue to them. We asked children and their families to tell us about pain, recovery using the arm, quality of life, complications encountered and school absences. We also looked at the financial costs to families and the NHS.
What did the trial find?
The two treatments resulted in the same outcomes. The majority of those offered a bandage chose to wear it immediately. There was no difference at all in the levels of pain between those treated with a hard splint and usual outpatient follow-up and those offered a bandage and discharge (i.e. no further follow up) from hospital the same day. Similarly, there was no difference in the recovery using the arm, quality of life, complications encountered or school absences. There was a very slight increase in pain killer use in the bandage group at day 1, but not at any other time point. Overall, the cost of the offer of a bandage was slightly lower for families and the NHS.
In conclusion, the findings of this study support offering a bandage to be used at the discretion of families to treat children with a torus fracture of the wrist.