A Randomized Controlled Trial of 2 Methods of Immobilizing Torus Fractures of the Distal Forearm

Abstract

Immobilization of torus fractures of the distal forearm, for 1 to 4 weeks in a slab, cast, or splint, produces good radiological and functional outcomes. This study assesses the pain associated with 2 forms of immobilization used for these injuries. A randomized controlled trial comparing fiberglass volar slab and encircling plaster-of-paris cast was conducted at a children's hospital emergency department. Patients presenting with torus fractures of the distal forearm were enrolled and reviewed after 2 weeks of immobilization. A daily questionnaire was used during immobilization to assess pain, satisfaction, and activity state of the child. Adequate data were available for 42 participants in each group. Immobilization in a volar slab was associated with the following: increased duration of pain, with a median of 6.0 days (interquartile range [IQR] 2.0-11.0) versus 3.0 days (2.0-5.0) P = 0.009, and an increased time to resumption of normal activity at 2 weeks 67% versus 95%, P = 0.001. Average daily pain severity was similar in the 2 groups (35 mm on visual analogue scale [VAS] for the cast group vs. 39 mm for the slab group), P = 0.48. Stratified analysis showed pain on enrollment of greater than 50 mm on VAS, which was a strong association for longer duration of pain in both groups, P < 0.001. Use of a slab may increase the duration of pain, especially in patients who had more severe pain at presentation.