Invictus Reviews

Healing Little Bones: A Focus on Torus Fractures

• Mel Herbert

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Pediatric emergency medicine is highlighted through a detailed discussion on torus fractures, their management, and the implications for treatment approaches. Ilene Claudius provides valuable insights into pediatric care, emphasizing the importance of community feedback and ongoing education for healthcare professionals.

• Ilene Claudius is our expert 
• Overview of torus fractures and typical causes related to childhood injuries 
• New evidence on treating torus fractures with minimal intervention 
• The role of removable splints in pediatric fracture management 
• Feedback from listeners shapes future podcast content 
• Discussion of a potential subscription-based educational model 
• Exciting future projects and upcoming announcements in pediatric care

Speaker 1:

Hey party people, mel Herbert here. Let's talk about what's happening with Invictus. I had a great recording session with Eileen Claudius. Of course you all know Eileen Claudius. Eileen is pediatric emergency medicine and adult emergency medicine trained. She trained at UCLA. When I was there, I was about I don't know we were just trying to work it out I think I was seven years ahead of her, but she was about 10 to 15 years ahead of me in terms of knowledge. So she did PEDS and EM and now is faculty at Harbour UCLA. We were both faculty at USC for a long time but anyway, she is a world expert in pediatric emergency medicine. Nobody does it better than Eileen. So I have her doing a whole bunch of pediatric talks.

Speaker 1:

We laid down in our little studio a couple of pediatric orthopedic talks and here is a tiny, tiny section that comes from that. There's also a link to the YouTube channel because this is visual again, but I'm laying down the audio here so you can listen to it if you're a listener. But the visuals are far better, as always, in particular with the visuals, we're looking for your feedback, your thoughts, your concerns, your loves, your dreams, your desires, whatever it is. On that note, I did ask for feedback on the last thing that we recorded, and I think it was Gita Pencer doing some nasty rashes, and I got a number of emails, so thank you. A very exciting one here is from Marcel. Marcel is in the Netherlands and he said that I would really like a combination of both podcasts and visuals. That would be really important. Certainly want a study guide to help get through all of this stuff.

Speaker 1:

And then we talked about what about, in order to accelerate this going live, doing it sort of as a monthly subscription where we just every week, add another hour, another hour, every week, add another hour, another hour, another hour, another hour, that kind of thing, and at least Marcel thought that was a good idea.

Speaker 1:

The reason to do that is that, instead of waiting for it all to get done and you can imagine that's a massive amount of work to record it all, to edit it, to upload it, to make the question sets, to do all this stuff takes a long time to do that, so we could delay going live with anything until it's all done, or we can start with a chunk of it and then keep adding to it as we go, and I am thinking about doing it that way. So I am actually off to Kenya for a couple of weeks, coming up here next week, going to do some teaching in a couple of hospitals in Nairobi and in Eldoret with our non-profit organization. So when I get back then we'll really get busy with the recording and we'll talk more about what you think about that as an idea. But until then, here is Eileen Claudius talking about a particular situation that occurs in kids and in this case when they fall on an outstretched limb. I learned all this.

Speaker 2:

And with a torus fracture it looks very similar. It is a buckling. It's also called a buckle fracture or a bowing out of the bone secondary to a compressive force. So the classic history. So you have a little kid, young bones, they have a fall on an outstretched arm and when you get the x-ray you see that compressive force has resulted in billowing out of that bone right there. Now this is a very stable fracture. If you completely miss this fracture and send the kid out to go about their life, they will probably be fine.

Speaker 2:

I'm 100% convinced that not only myself but probably a lot of you who are also very active children had a ton of these growing up that never came to care and never got treatment.

Speaker 2:

But now that we are seeing these kids and we are treating them in general, many torus fractures have historically been immobilized for two to three weeks and that is absolutely reasonable management. However, the vast majority of these are going to be in the distal radius because, like we said, it's often from a fallen and outstretched hand and in that case it is perfectly acceptable and probably even a little bit better from an adverse event standpoint, rather than using a splint or a cast, to use a removable Velcro splint, you get less skin breakdown, you get faster time to recovery and not only can they be managed in a removable splint, the family can actually remove it whenever the kid is doing fine, no longer complaining about pain, and able to do their normal activities. Now I generally will have these patients follow up with their pediatrician, but they definitely don't need follow up with an orthopedist and, honestly, if they didn't follow up with their pediatrician either, they would probably be fine to remove the splint at home and not get anything additional.

Speaker 1:

All right that little buckling at the wrist. That torus fracture really doesn't need much of anything done. In fact, just on the EMA part of the program of MRAP, we did a recent study that said just wrapping it, just like wrapping it in a little bandage, is just as good as splinting or anything else, so they really really don't need too much. Re-injury is probably the biggest deal, but good luck trying to stop the kids running around. So more coming soon. Are you watching the Pit? Are you watching the Pit? It is exceptional and I hope to have some very big announcements to make about the Pit soon, and I want to get Joe Sachs, who is the lead medical writer and one of the producers on the show, here to talk about what he's doing to make it so good. All right, talk to you soon, over and out.