Comparison of splint and conventional cast for treating wrist torus fractures in children (systematic review)

Abstract

Wrist torus fractures in children are common. Although it might be simple and straightforward, the management of these injuries remains controversial and depends on the personal experience and preference of the treating physician. The consensus agreement, however, is that these fractures are inherently stable. Some authors argue that splints should replace the traditional method of cast immobilisation. The splints are viewed as easier to use, more convenient and do not require follow up clinics for removal. It has also been argued that splints are more cost-effective than casts. The aim of this systematic review is to examine the effectiveness and cost-effectiveness of removable splints versus casts in the treatment of torus wrist fractures of children in the current literature. This review followed the Systematic reviews and Meta-Analyses (PRISMA) statement for reporting. Comprehensive electronic database search and handsearch were conducted. Studies were considered for review if they were randomised or quasi-randomised controlled trial and compared removable splints and casts for treating torus fractures of distal radius and/or ulna in children. Four papers identified by two reviewers as potentially eligible for inclusion were appraised and two identified for inclusion were further assessed for any risk of bias. Data were narratively presented and discussed as meta-analysis would not have been possible for the identified studies. The limited available data favours the use of splint as a clinically effective and more cost-effective method of immobilisation. However, the findings of the systematic review are limited by the quality of the identified studies. It has been viewed that explanation to patients and parents and involving them in the decision, plus implementation of safety protocol to avoid under-treatment of misdiagnosed fractures and allow easy access of patients to the clinic, is an alternative way to provide safe, convenient and cost-effective treatment.