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Simple bandage for wrist fractures could save the NHS money and benefit children worldwide, study trialled in Exeter finds

The results of a study carried out in the South West have demonstrated potential cost savings to the NHS by using a simple gauze bandage for common wrist fractures in children rather than a cast.

The NIHR Clinical Research Network South West Peninsula supported research staff at Royal Devon University Healthcare NHS Foundation Trust (RDUH) to recruit 24 children into the University of Oxford’s FORCE Study looking at the best treatment for common wrist fractures.

Torus fractures (also called buckle fractures) of the wrist are the most common type of broken bone in children. They are also the mildest form of broken bone, in which the bone crushes (or buckles), instead of breaking.

Despite being so common, there is no ‘standard’ or ‘agreed’ treatment. Traditionally doctors have used plaster casts and arranged outpatient follow-up. However, medical research suggested that wearing a bandage, or even having no treatment, might be similarly good.

A total of 965 children aged 4–15 years from 23 emergency departments in the UK took part in the FORCE study. Children were divided between the bandage and hard splint groups.

The results, recently published in The Lancet, demonstrated that the two treatments resulted in the same outcomes. The majority of those offered a bandage chose to wear it immediately. There was no difference at all in the levels of pain between those treated with a hard splint and usual outpatient follow-up and those offered a bandage and discharge (i.e. no further follow up) from hospital the same day. Similarly, there was no difference in the recovery using the arm, quality of life, complications encountered or school absences. There was a very slight increase in pain killer use in the bandage group at day 1, but not at any other time point. Overall, the cost of the offer of a bandage was slightly lower for families and the NHS.

Dr Andy Appelboam, Consultant Emergency Physician and Principal Investigator for the study at RDUH, said: “Torus wrist fractures are a really common injury with children attending emergency departments and minor injury units around the country and the world every single day. The evidence from this trial supports simple bandage treatment and discharge from follow up which will save staff, and more importantly children and their families time, without the need to routinely return to hospital.

“Bandage treatment is also cheaper and easier without compromising the recovery from this common injury. Adopting the findings from this study will benefit children, their families and healthcare around the world.”

Daniel Perry, Associate Professor, Orthopaedics and Trauma Surgery at NDORMS, University of Oxford, said: “It is a common belief amongst both families and clinicians that a fracture needs plaster cast immobilisation to ensure adequate healing. However, evidence suggested that a bandage or no treatment was just as effective. We started the FORCE trial because it was not clear how much difference each treatment made to a patient’s recovery.

“FORCE highlights the over-treatment that happens in many parts of practice. As doctors, we’ve always been taught to splint all broken bones – though in reality we know that many children with this injury present to hospital after several days as their parents considered it a wrist sprain, and indeed many almost certainly never come! As clinicians, we need to shift our mindset to consider buckle fractures as a wrist sprain and treat it with love and reassurance. With more research, perhaps we can move to a situation where we don’t even x-ray many wrist injuries in children.”

The study was funded by the NIHR Health Technology Assessment (HTA) Programme.

More information about the study can be found on the FORCE website.