A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm

Pediatr Emerg Care. 2008 Feb;24(2):65-70. doi: 10.1097/PEC.0b013e318163db13.


Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: Use of a slab may increase the duration of pain, especially in patients who had more severe pain at presentation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Absenteeism
  • Adolescent
  • Casts, Surgical*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Male
  • Pain Measurement
  • Radius Fractures / therapy*
  • Recovery of Function
  • Splints*
  • Treatment Outcome
  • Ulna Fractures / therapy*
  • Wrist Injuries / therapy