Case example I—Torus/buckle fracture
A 10-year-old boy presents to the Emergency Department (ED) complaining of wrist pain after a fall from his bicycle. The patient is examined by an ED physician or Orthopaedic consultant. Radiographic imaging of the wrist reveals a torus/buckle type fracture of the distal radius, without any angulation
Treatment before implementation of direct discharge	Treatment after implementation of direct discharge
A plaster cast/splint is applied in the ED  A follow-up appointment is scheduled in the fracture clinic in 7 days  After 7 days, the cast/splint is removed. Bandage and a sling are applied. Parents are instructed to remove the bandage in a few days as pain allows. No further imaging is performed  The patient is then discharged from follow-up with instructions regarding sports, etc	A removable wrist orthosis is applied in the ED  Verbal instructions are provided in the ED with regard to the injury, recovery, when to remove the orthosis, when to contact the hospital, etc  This is also summarized in a discharge leaflet and/or smartphone application  No follow-up appointments are scheduled  It is allowed to remove the orthosis e.g., to take a shower, and parents are instructed to permanently remove the orthosis after 7 days  If pain does not allow, then the orthosis can be used for another week  A special telephone helpline is available in case of any questions or concerns. If necessary, a face-to-face follow-up appointment is scheduled