Buckle Fracture
Buckle fractures, also known as a Torus fracture,is injuries that occur to either the radius, ulna or both usually due to a fall in young children.They’re an incomplete fracture, the break doesn’t go all the way through the bone.
A buckle fracture is a bend in part of the bone rather than a crack all the way across it.This occurs because children’s bones are more flexible than adult’s bones,therefore rather than completely snapping, only part of the bone ‘buckles’or ‘kinks’ instead.
Buckle fractures commonly affect the radius and ulna , but they can happen to any long bone.
Etiology
Buckle fractures occur almost exclusively in long bones of children, although they can also occur in flat bones - particularly rib fractures.The distal radius is among the most commonly broken bones during childhood. The mechanism of injury is by axial loading, which frequently occurs due to falling on an outstretched arm.
Epidemiology
Of all pediatric injuries, fractures constitute around 25% of hospital attendance.Distal radius and buckle fractures make up 27.2%, which, by far, is the most common bone to be injured and sustain a buckle fracture.Specifically, 50% of pediatric wrist fractures are buckle fractures.These injuries occur throughout the pediatric age range but are particularly common between the ages of 7 to 12 years old.
Pathology
Buckle fractures occur when there is axial loading of a long bone. This most commonly occurs at the distal radius following a fall ,the force is transmitted from carpus to the distal radius and the point of least resistance fractures, usually the dorsal cortex of the distal radius.
Symptoms of a buckle fracture
•Pain.
•Swelling.
•Tenderness.
•Bruising or discoloration.
Diagnosis
Buckle fracturs can be identified by a radiograph such as X-rays.
Differential Diagnosis
•Buckle fracture
•Greenstick fracture
•Salter-Harris fracture
•Toddler’s fractures – undisplaced spiral fractures of the distal tibia
•Plastic deformation
•Soft tissue injury
•Non-accidental injury
What treatments are available?
Buckle fractures heal well by themselves. A bandage can be applied to the wrist and most children will start to use their wrist and hand comfortably after a couple of weeks. They can use their hand as much as they would like but should not do anything that causes them pain or discomfort. If the child wears a bandage this should be removed whenever the wrist becomes more comfortable and certainly by three weeks.When moving the wrist in the next few weeks they may complain of mild stiffness and aching. This is normal andshould settle down quickly.
Prognosis
Of all pediatric fractures, buckle fractures have an excellent prognosis. They are inherently stable, without any real risk of displacement or long-term sequelae, largely due to an intact, thick periosteum around the entire cortex. Also, there is excellent remodeling potential at the distal radius. Therefore, these patients can be safely discharged after their first presentation without the need for follow-up.
Complications
Complications are rare and do not relate to the actual injury but rather to the treatment. Some rare incidences of blistering or joint stiffness due to prolonged use of non-removable casts. Thus, the preference for treatment has shifted towards removable wrist splints or pre-fabricated removable casts.
