ArticleCureus2026
Optimising Management of Paediatric Distal Radius Torus Fractures: A Complete Two-Cycle Audit Assessing Compliance With National Institute for Health and Care Excellence (NICE) Guideline NG38.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundDistal radius torus (buckle) fractures are among the most common paediatric injuries presenting to emergency departments. National Institute for Health and Care Excellence (NICE) guideline NG38 recommends management with non-rigid immobilisation and discharge without routine follow-up. Despite robust evidence supporting this approach, clinical practice varies considerably across NHS settings.
aimThis study aims to assess baseline compliance with NICE NG38 in the management of paediatric distal radius torus fractures, implement targeted quality-improvement interventions, and evaluate their effect through a complete closed-loop audit cycle.
methodsA retrospective two-cycle clinical audit was conducted at a District General Hospital (DGH) and its associated Minor Injury Unit (MIU) within the same NHS trust in the United Kingdom. Cycle 1 (February 2023 to August 2023, n = 222) established baseline practice. Interventions included clinician education, guideline dissemination, and visual prompts. Cycle 2 (March 2024 to September 2024, n = 258) evaluated post-intervention practice. Data were collected from electronic emergency department records, radiographic systems, and Virtual Fracture Clinic (VFC) documentation.
resultsIn Cycle 1, compliance with NICE NG38 was 97/174 (56%) at the DGH and 0/48 (0%) at the MIU; 128/222 (58%) of all patients across both sites received unnecessary fracture clinic follow-up. Following interventions, Cycle 2 demonstrated improved compliance to 131/164 (80%) at the DGH and 29/94 (31%) at the MIU. Overall fracture clinic follow-up was reduced from 128/222 (58%) to 98/258 (38%). Rigid immobilisation persisted in 33/164 (20%) of DGH patients and 65/94 (69%) of MIU patients in Cycle 2.
conclusionThis closed-loop audit demonstrates that targeted educational and environmental interventions can meaningfully improve adherence to evidence-based guidelines and reduce unnecessary fracture clinic referrals. However, variability in immobilisation practice persists, particularly at the MIU, underscoring the need for sustained system-level interventions, standardised clinical pathways, and ongoing audit cycles.
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