UMEM Educational Pearls

Home management versus PCP follow-up of patients with distal radius buckle (torus) fractures

 

A recent study investigated outcomes of patients with distal radius buckle fractures who were randomized to

 

  1. Home removal of splint and physician follow-up as needed (home management)  

 

Versus

 

  1. Prescribed PCP follow-up in 1-2 weeks


 

Noninferior study

 

Torus/buckle fractures of the distal radius are the most common fractures in childhood occurring on average in 1 in 25 children

 

This is a stable fracture typically treated with removable wrist splint and very rarely require orthopedic intervention

 

Outcome: functional recovery at 3 weeks

 

Randomized controlled trial at a tertiary care children’s hospital

 

All radiographs reviewed by pediatric radiologist with MSK specialization

 

149 patients. Mean age 9.5 years. 54.4% male

 

Telephone follow-up at 3 and 6 weeks following ED discharge by blinded interviewer

 

Primary outcome was comparison of Activities Scale for Kids-performance scores between groups at 3 weeks

 

Outcomes:  Home management performance score was 95.4% and PCP follow-up group was 95.9%. Mean cost savings were $100.10.

 

Conclusion:  Home management is at least as good as PCP follow-up with respect to functional recovery in ED patients with distal radius buckle fractures.

 

 

 

 

References

Colaco et al. Home management versus primary care physician follow-up of patients with distal radius buckle fractures: A randomized controlled trial. Ann Emerg Med. 2021