FORCE

Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK

Perry DC, Achten J, Knight R, et al. Lancet (London, England) 2022 · PMID 35780790 · doi:10.1016/s0140-6736(22)01015-7

Question

For children with torus (buckle) fractures of the distal radius, is offering a soft bandage and immediate discharge equivalent to rigid immobilisation?

Design

Pragmatic multicentre equivalence RCT in 23 UK hospitals.

Patients

Children aged 4 to 15 with a torus fracture of the distal radius.

Intervention

Offer of a soft bandage with immediate discharge and no routine follow-up

Comparison

Rigid immobilisation in a cast or splint with follow-up as per local practice

Primary outcome

Pain (Wong-Baker FACES) at 3 days

Key result

Pain at 3 days was equivalent between the bandage and rigid immobilisation groups in both intention-to-treat and per-protocol analyses.

Limitations

Diagnosis relied on treating clinicians and excluded more complex fractures, so accurate identification of a true torus fracture is essential.

Impact on practice

Children with a confirmed torus fracture can be offered a soft bandage and discharged without routine fracture clinic follow-up, in keeping with NICE NG38.