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 is can be classified as an incomplete fracture. The compressive force is provided by the

trabeculae A trabecula (plural 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 ...

and is longitudinal to the axis of the long bone. 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 stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

. 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 ...

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 any other part 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 ...

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 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 usually slightly longer tha ...

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

Diagnosis

Buckle fracturs 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 radiography ("diagnostic" and "therapeut ...

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

lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction * Lateral cricoarytenoid muscle * Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral co ...

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 (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...

. * 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

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 in England that publishes guidelines in four areas: * the use of health technologies withi ...

(NICE), which was published before th
FORCE study
identified that all treatments appeared safe and recommended either a removable splint or a bandage, without the need for a follow-up. Other studies have also shown that, with removable splints that can be taken off at home, without the need for outpatient clinics, parental satisfaction of nearly 100% is achieved. Th
FORCE study
also published a package of dissemination materials (i.e. cartoons/ leaflets/ treatment pathways) for parents, children and clinicians to best implement the results in clinical practice
available here

References

External links

FORCE Trial
{{Fractures Bone fractures