A Torus fracture, also known as a buckle fracture is the most common fracture in children. It is a common occurrence following a fall, as the wrist absorbs most of the impact and compresses the bony

cortex Cortex or cortical may refer to: Biology * Cortex (anatomy), the outermost layer of an organ ** Cerebral cortex, the outer layer of the vertebrate cerebrum, part of which is the ''forebrain'' *** Motor cortex, the regions of the cerebral cortex i ...

on one side and remains intact on the other, creating a bulging effect. As the bulge is only on one side of the bone, this injury can be classified as an incomplete fracture. The compressive force is provided by the

trabeculae A trabecula (: trabeculae, from Latin for 'small beam') is a small, often microscopic, tissue element in the form of a small beam, strut or rod that supports or anchors a framework of parts within a body or organ. A trabecula generally has a ...

and is longitudinal to the axis of the

long bone The long bones are those that are longer than they are wide. They are one of five types of bones: long, short, flat, irregular and sesamoid. Long bones, especially the femur and tibia, are subjected to most of the load during daily activities ...

, meaning that the fracture itself is orthogonal to that axis. The word "torus" originates from the Latin word "protuberance." Buckle_Fracture

$Buckle_fracture_of_the_Radius$

Signs and symptoms

Torus fractures are low risk and may cause acute

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

. As the bone buckles (or crushes), instead of breaking, they are a stable injury as there is no displacement of the bone. This mechanism is analogous to the

crumple zones Crumple zones, crush zones or crash zones are a structural safety feature used in vehicles, mainly in automobiles, to increase the time over which a change in velocity (and consequently momentum) occurs from the impact during a collision by a ...

in cars. As with other fractures, the site of fracture may be tender to touch and cause a sharp pain if pressure is exerted on the injured area.

Risk factors

Physical activities or sports such as bike riding or

climbing Climbing is the activity of using one's hands, feet, or other parts of the body to ascend a steep topographical object that can range from the world's tallest mountains (e.g. the eight thousanders) to small boulders. Climbing is done for locom ...

increase the associated risk for buckle fractures in the potential event of a collision or fall. As aforementioned, the most common buckle fracture is of the

distal radius The radius or radial bone (: radii or radiuses) is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is longer ...

in the forearm, which typically originates from a Fall Onto an Outstretched Hand ( FOOSH). Such orthopaedic injuries are distinctive in children as their bones are softer and in a dynamic state of bone growth and development, with a higher

collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...

to bone ratio so incomplete fractures such as the buckle fracture are a more common occurrence.

Diagnosis

Buckle fractures can be identified by performing a

radiograph Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiography and "therapeu ...

. The diagnosis of a torus fracture is made from both anterior/posterior and

lateral Lateral is a geometric term of location which may also refer to: Biology and healthcare * Lateral (anatomy), a term of location meaning "towards the side" * Lateral cricoarytenoid muscle, an intrinsic muscle of the larynx * Lateral release ( ...

projections. The typical features include: * The buckling of cortical bone, which may appear as a small bulge or protuberance in the radius or

ulna The ulna or ulnar bone (: ulnae or ulnas) is a long bone in the forearm stretching from the elbow to the wrist. It is on the same side of the forearm as the little finger, running parallel to the Radius (bone), radius, the forearm's other long ...

. * The bone may have a slight angulation.

Treatment

There is no established 'standard' treatment for buckle fractures. However, in 2022 the largest and highest quality treatment study was published about this injury in the Lancet medical journal - called th
FORCE Study
(see infographic in images). The study was conducted throughout the UK in 21 emergency departments. This study fairly allocated children (through randomisation) to either splint and routine follow-up, or a bandage and no follow-up. 965 children were in this study, which showed equivalent results for pain scores, function and complications between the treatments. This offered clinicians, parents and young people reassurance that this fracture will heal well, without complications and immobilisation and follow-up is almost always not needed. Furthermore, a national guideline from the UK's

National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body of the Department of Health and Social Care (United Kingdom), Department of Health and Social Care. As the national health technolog ...

(NICE), which was published before that study, identified that all treatments appeared safe, without the need for a follow-up. Other studies have also shown that parental satisfaction of nearly 100% is achieved when using removable splints that can be taken off at home without the need for outpatient clinics, .

References

External links

FORCE Trial
{{Fractures Bone fractures