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The Pediatric Forum
July 2000

No Radiograph in the Management of Pediatric Torus Fractures

Arch Pediatr Adolesc Med. 2000;154(7):750. doi:

In reply

We acknowledge the thoughtful comments of Dr Samsamy regarding the management of the torus fracture. Dr Samsamy is correct that logic "leads one to conclude that not a single study is needed in the follow-up of pediatric torus fractures." We struggled over the final message to our readers: whether a patient with a documented torus fracture requires any follow-up study (films) at all. Indeed, we found no data to support any follow-up study. However, as we considered the evidence of our study, a review of a series of 70 patients, we felt compelled to avoid making claims that our data would not support. A negative conclusion requires sufficient power to support the null hypothesis, that no follow-up study is required. Our series lacks such power. In addition, one expert in pediatric orthopedic surgery whom we surveyed did use a follow-up study in select cases. We therefore settled on the conclusion that perhaps a single follow-up study has a role in the management of torus fractures. We believe that a larger series would show, as Dr Samsamy correctly suggests, that true torus fractures need no follow-up studies at all.