Soft bandages and rigid casts are comparable in children with torus fractures of the wrist (FORCE)

Reference

Perry DC, Achten J, Knight R, et al, for the FORCE Collaborators in collaboration with PERUKI. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet 2022;400(10345):39-47.

Synopsis

The Forearm Fracture Recovery in Children Evaluation (FORCE) study took place in 23 emergency departments and enrolled children 4 years to 15 years of age with radiographically confirmed torus fractures of the distal radius who arrived for care within 36 hours of injury. The researchers randomized the children to 1 of 2 approaches to immobilization. One group was offered a soft bandage (n = 89) and the other group was treated with a rigid device (n = 476). In the former group, the elastic bandage was either applied immediately in the emergency department (94% chose this option) or given to the family to be applied at home at their discretion. The children treated with a rigid device either used a removable splint (95%) or a cast. In addition to evaluating pain with a validated 10-point scale that used the Wong-Baker FACES Pain Rating Scale to illustrate pain severity (minimum clinically important difference is a 2-point change), the researchers assessed function and quality of life at baseline, 3 days, 7 days, 3 weeks, and 6 weeks. At the end of the study, the researchers did not have outcome data on 6% of the participants. Although the authors used intention-to-treat analysis to evaluate the outcomes, they report that 7% of the children in the bandage group switched over to rigid casts (mostly because of pain) while only 0.2% of the casted children converted to bandages. After 3 days (the primary outcome), the pain level for those given a bandage was 3.2 compared with 3.1 in those treated with rigid devices. None of the evaluations showed either intervention to be superior to the other in pain, function, or quality of life. Complications occurred in approximately 1% of each group and none required more than the application of a rigid cast, largely due to a change in the fracture diagnosis after the radiologist's final radiograph interpretation. Finally, the participants in each group missed a median of 1.5 school days.