Understanding Buckle Fracture in Children

When bones bend but don't completely break

Doctor caring for girl with arm in sling while father watches
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A buckle fracture also called a torus fracture, is an extremely common injury seen in children. Because children have softer, more flexible bones, one side of the bone may buckle upon itself without disrupting the other side of the bone—also known as an incomplete fracture.

There are two common types of incomplete fractures that occur in children:

  • Buckle Fractures: These injuries occur when the bone compresses and is therefore considered a "compression" injury. The side of the bone under compression crunches down upon itself causing the bone to crumple on just the one side of the bone.
  • Greenstick Fractures: These fractures are injuries that occur when the bone is pulled too far on one side of the bone—a "tension" injury. The bone on the greenstick side of the injury is pulled apart (as opposed to being compressed upon itself).

Signs of a Buckle Fracture

The most common symptoms of a buckle fracture are pain and swelling. Seldom is there any actual deformity, although if there is a lot of swelling the extremity may look slightly deformed. The word torus is derived from the Latin word "Tori," meaning swelling or protuberance. Children commonly sustain this injury by falling on an outstretched hand.

Other signs of a buckle fracture may include:

  • Swelling
  • Pain with pressure or movement
  • Bruising of the skin

Buckle fractures don't occur in adults because the adult bone is less elastic. A child's bone can withstand some deforming force, and therefore these incomplete fractures can occur.

Adult bone is more like a porcelain plate that when it fails it cracks all the way through. 

Treatment of Injuries

Treatment of a buckle fracture is accomplished by immobilizing the injury for a short duration, usually about three or four weeks. These injuries tend to heal more quickly than the similar greenstick fractures.

 There have been many studies comparing casting versus splinting for buckle fractures. The common conclusion is neither treatment is better.

The advantage of a cast is that it protects the injured area very well. Kids wearing a cast seldom complain of pain, and even when active the bone is well protected. Kids can't remove the cast, and therefore parents don't need to worry about their child being complaint about the recommended treatment.

The advantage of a splint is that it is a simpler treatment that is more flexible. Splints can be removed to allow for bathing and washing, and parents can remove the splint once healing is complete.

Deciding on the best treatment depends on the specific fracture, the comfort of the child and the comfort of their parent with the proposed treatment. When your child has a buckle fracture you can discuss treatment options with your doctor. I find that most kids who end up with a cast do so because of the excitement of having a cast to show their friends. 

Long-Term Problems

Most buckle fractures will heal completely with no long-term issues for the patient. Because these fractures are not significantly displaced, and typically they are not growth plate fractures, there is usually no effect on the long-term health of the bone for the child.

In order to ensure optimal success with treatment, it is important to ensure that appropriate treatment is being followed.

Many parents are concerned that something could be wrong with the bone when their child sustains a fracture. Rest assured that nearly all buckle fractures are normal childhood injuries that heal uneventfully and don't occur because of a problem other than a normal, rambunctious child. That said, if the fracture occurs without any known injury or there are multiple buckle fracture injuries, it is worthwhile to discuss with your doctor. There are tests that can be performed to assess bone health, however, these do not need to be performed under normal circumstances.

Sources:

Pandya NK, Upasani VV, Kulkarni VA. The pediatric polytrauma patient: current conceptsJ Am Acad Orthop Surg. 2013 Mar;21(3):170-9.

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