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Torus Fracture

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Other Names

  • Buckle Fracture
  • Circumferential buckle fracture

Background

  • Refers to incomplete fracture to the shaft of long bones characterized by bulging of the periosteum cortex
  • Note this page refers to torus fracture of the distal Radius, although they can occur elsewhere in children
  • Torus is Latin (tori) for protuberance

Epidemiology

  • Ages 5-10 most commonly (need citation)
  • Represent 50% of pediatric wrist fractures[1]

Pathophysiology

  • Involves fall on outstretched hand
  • Distal radius is most vulnerable bone to force vectors
  • Due to elasticity of bones, the cortex 'buckles'

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features


Evaluation

Radiographs

  • Standard Radiographs Wrist
  • Typically of wrist or forearm initially, depending on patients area of pain
  • No distinct fracture line
  • Subtle finding of interruption of edge of cortex, often described as 'buckle' or deformity
    • Seen on dorsal bone with distal fragment angulated dorsally, volar cortex usually intact
    • Usually 2 - 3 cm proximal to physis
  • Angulation may be only diagnostic clue

Classification

  • N/A

Management

Nonoperative

  • Nonsurgical, can follow up with pediatrician or primary care doctor
  • If angulation is severe, may require manipulation
  • Splint: Sugar Tong Splint
  • Cast: Short Arm Cast
  • Removable prefabricated wrist splint becoming more popular
    • Better physical function, less difficulty with daily activities and a strong parental preference[2]
  • Not associated with cosmetic or functional consequences[3]

Operative

  • Indications unclear
  • Should see orthopedic surgeon if not fully recovered at 6 weeks

Return to Play

  • Constant immobilization for 2-3 weeks
  • Avoid injurious activities for 2 weeks out of splint
  • Resume full activities 4-6 weeks[4]

Complications

  • None?

See Also


References

  1. Naranje, Sameer M., et al. "Epidemiology of pediatric fractures presenting to emergency departments in the United States." Journal of Pediatric Orthopaedics 36.4 (2016): e45-e48.
  2. Plint, Amy C., et al. "A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children." Pediatrics 117.3 (2006): 691-697.
  3. Wilkins, Kaye E. "Principles of fracture remodeling in children." Injury 36 (2005): A3-11.
  4. Koelink, Eric, et al. "Primary care physician follow-up of distal radius buckle fractures." Pediatrics 137.1 (2016): e20152262.
Created by:
John Kiel on 13 November 2019 17:26:47
Authors:
Last edited:
13 October 2022 21:56:31
Categories:
Trauma | Pediatrics | Wrist | Forearm | Upper Extremity | Acute