What is Pediatric Torus Buckle Fracture?
The structure of a child’s skeleton is unique and different from an adult’s. Key differences include a growth section called the physeal growth plate and a thicker layer of tissue called the periosteum covering soft bone. With this softer bone covered by a robust layer of periosteum, minor injuries can cause a range of deformities, with or without a break in the bone’s outer layer (cortical break).
In longer bones, injuries without a cortical break can cause the bone to deform or create a ‘kink’ in the bone. This kink is often referred to as a ‘buckle’ or ‘torus’ fracture. It appears on x-rays as two bone bulges, as if the bone has been squished or ‘buckled.’
The term ‘torus’ comes from the Latin word for ‘bulge.’ But, if there is a fracture with a break in the bone’s outer layer, it’s called a greenstick fracture if it only affects one side of the bone, and a complete fracture if it affects both sides.
Buckle fractures are incredibly common injuries seen in emergencies. They are usually managed with non-surgical treatments and typically don’t require a specialist in bone and muscle disorders (an orthopedic doctor).
What Causes Pediatric Torus Buckle Fracture?
Buckle fractures usually happen in the long bones of children, but they can sometimes happen in flat bones, like ribs. The bone at the end of the arm, the distal radius, is one of the bones children most frequently break. These fractures are often caused by an impact on the arm, which usually happens when a child falls onto an extended arm.
Risk Factors and Frequency for Pediatric Torus Buckle Fracture
Fractures account for roughly 25% of all injuries in children that require a hospital visit. The distal radius bone, which is often a site of what’s known as a ‘buckle’ fracture, is injured more commonly than any other bone, accounting for 27.2% of such injuries. In fact, half of all wrist fractures in children are buckle fractures. While these injuries can occur at any age in children, they are particularly common in those aged between 7 to 12 years old.
- Fractures are behind about 25% of all hospital visits for injuries in children.
- The distal radius bone is the most commonly injured bone, causing 27.2% of these injuries.
- Buckle fractures, a certain type of injury to the distal radius, are particularly common and make up 50% of all pediatric wrist fractures.
- These injuries can happen to kids of any age, but are particularly frequent in children aged 7 to 12 years old.
Signs and Symptoms of Pediatric Torus Buckle Fracture
When dealing with injuries, it’s crucial to understand how the injury happened and check for any other possible injuries to ensure nothing is overlooked. This process is especially vital when dealing with trauma cases.
In examining the injury physically, it’s important to look closely for any visible deformities. Additionally, part of a standard injury assessment involves checking for signs like bruising, swelling or bone tenderness around the injury area, as these may point towards a fracture. It’s worth noting that even if X-rays show a small buckle fracture, if there is a visible deformity, there could also be a plastic deformation that needs to be corrected.
When dealing with children, there is always a need to be cautious of non-accidental injuries. This caution requires a continual high level of suspicion, especially if there are inconsistencies in the story of how the injury occurred, if there’s a delay in seeking medical attention, if there are multiple injuries of different ages, or if the injury does not match the given story of how it happened.
Testing for Pediatric Torus Buckle Fracture
If there’s a suspicion of a broken bone, two different X-ray views are needed to check the fracture site accurately for any break in the outer layer of the bone and the degree of misalignment. Typical X-ray results might show a bulge on one or both sides of a long bone, with or without the bone being out of shape. There may also be a plastic deformation of a nearby bone – for example, the ulna bone in fractures of the distal radius, which is the larger bone in the forearm. If the doctor thinks this might be the case, they could also use an X-ray of the other limb for comparison.
In addition to this, depending on how the injury happened and the symptoms, more X-rays may be needed to check for other related injuries. For instance, if there is a buckle fracture in the distant part of the radius (the larger bone in the forearm), there could be fractures or dislocations in the supracondylar area (the region just above the elbow) or the radial head (the top of the radius where it fits into the elbow joint). This is why it’s a good rule of thumb to always check for injuries in the joints above and below the site of the fracture.
Treatment Options for Pediatric Torus Buckle Fracture
The main goal when treating buckle fractures is to ensure the patient is comfortable and that the parents understand the situation. Buckle fractures are typically stable injuries that rarely need any additional treatment.
After taking a patient’s medical history, conducting a physical examination, and confirming a buckle fracture through X-rays, the treatment usually involves the use of removable wrist splints, pre-made removable casts, or soft casts. The parents can remove these at home once the treatment is done. The casts or splints are generally needed for two to three weeks, as these fractures are considered stable.
Research has indicated that removable splints are optimal for treating buckle fractures. They make daily activities easier, improve physical function, and are typically preferred by both patients and parents compared to a cast that covers the entire forearm. The patient can safely go home after receiving instructions about when to remove the splint or soft cast and the need to avoid high-contact sports or dangerous activities for six to eight weeks after the injury.
Ideally, these treatments occur directly in the emergency room, and the patient can go home afterward. However, in many instances, patients may be referred to a fracture clinic for a follow-up.
What else can Pediatric Torus Buckle Fracture be?
When a child has a fall or injury, they may end up with one of a variety of bone injuries or fractures such as:
- Buckle fracture: a type of fracture where one side of the bone bends or “buckles” without breaking the other side.
- Greenstick fracture: a type of fracture where the bone bends and cracks, without fully breaking; it’s like bending a green twig.
- Salter-Harris fracture: a fracture that affects the area of a child’s bone that’s still growing.
- Toddler’s fractures: these are fractures that don’t shift position and usually occur in the lower part of the shinbone.
- Plastic deformation: this is when a bone bends out of shape but doesn’t break. It usually happens in children because their bones are still soft and flexible.
- Soft tissue injury: this refers to damage caused to the tissues in the body that aren’t bone.
- Non-accidental injury: these are injuries that are caused intentionally and not due to an accident or fall.
It’s crucial to correctly identify what kind of injury a child has had so that they can receive the right type of treatment.
What to expect with Pediatric Torus Buckle Fracture
Buckle fractures, which are common in children, have great outcomes. Because of a thick layer of tissue surrounding the entire bone, these fractures are very stable and carry virtually no risk of complications or long-term issues. Excellent recovery can be expected, particularly at the lower arm bone end.
This means that patients with buckle fractures can be safely sent home after their first doctor’s visit, without the need to schedule a follow-up appointment.
Possible Complications When Diagnosed with Pediatric Torus Buckle Fracture
Complications related to wrist injuries are uncommon and are usually connected to the treatment rather than the injury itself. Some experts have observed rare cases where long-term use of casts that can’t be removed has caused blistering or joint stiffness. As a result, the preferred treatment method has changed to using removable wrist supports or casts that can be easily taken off.
Preventing Pediatric Torus Buckle Fracture
Kids are bound to get hurt now and then given the nature of their play and the fact that they often fall on outstretched hands. But, when they do get hurt, it’s important to check the injury quickly to make sure they haven’t broken any bones. If they have a fracture, a removable cast is usually necessary. Another important aspect to help your child recover fast and well, is to educate yourself as a parent on the proper way to take care of the cast.
It’s also a good idea to keep your child away from high-risk activities such as contact sports or any activity where they could easily fall again, for up to two months after the injury. This helps to prevent additional injuries.