Torus fracture

Torus fracture
Other names: Buckle fracture
X-ray of a torus fracture involving the distal radius
Specialty	Emergency medicine
Symptoms	Pain[1]
Usual onset	5 and 10 years old[2]
Causes	Fall onto an outstretched hand[1]
Diagnostic method	Plain X-ray[1]
Differential diagnosis	Greenstick fracture, Salter-Harris fracture, toddler’s fracture[3]
Treatment	Tensor bandage for up to a few weeks, splint[4][2]
Prognosis	Excellent[3]
Frequency	Common[1]

Torus fracture, also known as a buckle fracture, is a type of broken bone that generally occurs in children in which the outer aspect only buckles rather than fully breaks.^[2][3] Symptoms generally include pain to the affected area.^[1] Associated injuries may include plastic deformation.^[3]

It typically results from a fall onto an outstretched hand.^[1] Though other causes may include non-accidental injury.^[3] The distal forearm is most often affected; though, it may also involve the ribs.^[1][2] Diagnosis is generally by X-ray.^[1]

A simple soft bandage, like a tensor bandage for up to a few weeks, appears sufficient; with no requirement for dedicated follow-up.^[4][1] Pain medications, such as paracetamol and ibuprofen may be used.^[1] A removable splint may occasionally be used.^[2][3] Torus fractures are common.^[1] They generally occur in children between the ages of 5 and 10 years.^[2] The name is from the Latin for "protuberance".^[2][5]

Signs and symptoms

Torus fractures are low risk and may cause acute pain. As the bone buckles (or crushes), instead of breaking, they are a stable injury as there is no displacement of the bone.^[6] This mechanism is analogous to the crumple zones 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 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 in the forearm, which typically originates from a fall onto an outstretched hand (FOOSH).^[7] 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 to bone ratio so incomplete fractures such as the buckle fracture are a more common occurrence.^[8]

Diagnosis

Buckle fractures can generally be identified by X-ray. The diagnosis is made from both anterior/posterior and lateral 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 bone may have a slight angulation.^[9]

Treatment

The UK's National Institute for Health and Care Excellence (NICE), states that all treatments appeared safe, without the need for a follow-up.^[10] A simple soft bandage, like a tensor bandage appears sufficient.^[4]

A 2022 study found splint and routine follow-up, or a bandage and no follow-up had equivalent results for pain, function and complications.^[11]

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.^[12]

References

External links

• FORCE Trial