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Torus Fracture
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Contents
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
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
Clinical Features
- General: Physical Exam Forearm
- History
- Fall or trauma
- Physical Exam
- Tender to palpation at distal radius
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
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ 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.
- ↑ 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.
- ↑ Wilkins, Kaye E. "Principles of fracture remodeling in children." Injury 36 (2005): A3-11.
- ↑ 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
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Last edited:
13 October 2022 21:56:31
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