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. 2010 Aug;4(4):321-6.
doi: 10.1007/s11832-010-0269-3. Epub 2010 Jul 2.

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study

Ippokratis Pountos, John Clegg, Asim Siddiqui

Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study

Ippokratis Pountos et al. J Child Orthop. 2010 Aug.

Abstract

Objective: The management and the diagnostic modalities used in cases of undisplaced greenstick and torus fractures of the distal radius in children vary between different treatment centres. The aim of this study was twofold: firstly, to analyse the sensitivity of X-rays versus ultrasound to diagnose these fractures; secondly, to compare three available treatment options (plaster cast, Futuro splints, and double Tubigrip) in terms of pain, analgesia requirements, grip strength, deformity, stiffness and interference with a child's activities of daily living.

Methods: We prospectively included 79 patients suffering from undisplaced greenstick and torus fractures of the distal radius. Patients were randomized (single blindly) to the studied treatment groups.

Results: In terms of diagnosis, the ultrasound was found to be more sensitive than X-rays for diagnosing these fractures. Our results also showed that Tubigrip was superior in terms of interference with a child's ADLs, stiffness and grip strength. However, there was no difference in the levels of pain, analgesia required, and deformity.

Conclusion: These results support the idea that ultrasound is an effective and sensitive tool for detecting undisplaced greenstick and torus fractures of the distal radius in children. Treating these fractures with functional nonrigid devices (Tubigrip) results in improved function without increased discomfort or deformity.

Keywords: Greenstick; Torus; Ultrasound.

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Figures

Fig. 1
Fig. 1
X-ray and ultrasound appearance of an acute undisplayed fracture of the distal third of the radius. The fracture appears on ultrasonography as a hypoechoic zone
Fig. 2
Fig. 2
X-ray and ultrasound appearance of the same fracture at 6 weeks. Note the appearance of callus as seen on ultrasonography
Fig. 3
Fig. 3
Graphical representation of pain scores vs. treatment results
Fig. 4
Fig. 4
Graphical representation of analgesia requirement vs. treatment results
Fig. 5
Fig. 5
Graphical representation of paediatric disability score vs. treatment results
Fig. 6
Fig. 6
Graphical representation of deformity vs. treatment results
Fig. 7
Fig. 7
Graphical representation of grip strength vs. treatment results
Fig. 8
Fig. 8
Graphical representation of stiffness vs. treatment results
See this image and copyright information in PMC

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