Buckle Fracture in Children

When Bone Bends But Doesn't Completely Break

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

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

  • Buckle Fractures: These occur when the bone compresses, and is therefore a compression injury.  The side of the bone under compression crunches down upon itself causing the bone to crumple on the one side of the bone.
  • Greenstick Fractures: These fractures are tension injuries and 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.

Buckle fractures don't occur in adults because 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 with 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.

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.

Also Known As: Torus Fracture

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