Treatment of torus fractures in the forearm in children using bandage therapy.

BACKGROUND: In a torus fracture, there is an intact cortex at the side of the fracture which gives more intrinsic stability than in greenstick fractures, where one side of the cortex is disrupted. Two previously done studies compared soft bandage therapy (BT) with cast therapy in the treatment of torus forearm fractures in children and showed this is safe and does not cause any complications. The aim of our study was to validate these studies by treating all patients presenting to emergency department with a torus fracture with BT and investigate whether any complications occur. METHODS: At a single-center from January 2009 to June 2009, all patients with an impacted greenstick fracture of the distal radius and/or ulna without exception were treated using BT. Primary endpoint was secondary angulation; secondary endpoint was pain on Visual Analog Score. RESULTS: Seven patients were misdiagnosed as torus fractures but were actually greenstick fractures and had to be excluded. A total of 49 patients with a torus fracture were included in statistical analysis. No fracture displacement was seen. Four patients needed an additional nonsteroidal antiinflammatory drug or an antalgic plaster cast. The overall Visual Analog Score of the patients was lower than in previous studies. CONCLUSIONS: Soft BT is safe in all children without risk of further angulation and with a pain score equal to cast therapy. Important is that misdiagnosis of the torus fracture at initial presentation should be minimized.

Safety and efficiency of triaging low urgent self-referred patients to a general practitioner at an acute care post: an observational study.

OBJECTIVE: To assess the safety and efficiency of triaging low urgent self-referred patients at the emergency department (ED) to a general practitioner (GP) based on the Manchester triage system (MTS). METHODS: All self-referred patients in the evening, night and weekends were included in this prospective observational study. Patients were triaged by an ED nurse according to the MTS and allocated to a GP or the ED according to a predefined care scheme. For patients treated by the GP, assessments were made of safety as measured by hospitalisation and return to the ED within 2 weeks, and efficiency as measured by referral to the ED. RESULTS: In 80% of cases allocation of the self-referrals to the ED or GP was according to a predefined scheme. Of the 3129 low urgent self-referred patients triaged to the GP, 2840 (90.8%) were sent home, 202 (6.5%) were directly referred to the ED, 36 (1.2%) were hospitalised. Within a random sample of low urgent patients sent home by the GP (222 of 2840), 8 (3.6%) returned to the ED within 2 weeks. Against the agreed MTS scheme, the ED also directly treated 664 low urgent patients, mainly for extremity problems (n=512). Despite the care agreements, 227 urgent patients were treated by the GP, with a referral rate to the ED of 18.1%, a hospitalisation rate of 4.0% and a 4.5% return rate to the ED within 2 weeks. CONCLUSIONS: Low urgent self-referrals, with the exception of extremity problems, were shown to be treated efficiently and safely by a GP. A selected group of more urgent patients also seem to be handled adequately by the GP. Triage of low urgent patients with extremity problems and reasons for nurses not following a predefined triage allocation scheme need further elaboration.