Treatment goals in buckle fractures are for patient comfort and parental reassurance. Therefore, an ever-present high index of suspicion is required, particularly if any inconsistencies in the history, delayed presentation, multiple injuries of different ages, or if the mechanism of injury does not equate to the given fracture pattern. One must also be aware that although radiographs may show a buckle fracture if a clinical deformity exists, there may also be a plastic deformation that requires correction.įinally, with children, one must always be wary of non-accidental injury (NAI). Additionally, general principles for the assessment of any bruising, swelling, or bony tenderness around the site of injury may indicate a fracture. Like with every trauma case, one should ascertain if there are any other injuries and to make sure this is not a distracting injury to something more pressing.ĭuring the physical examination, inspection is key, and one must assess for any clinical deformities. ![]() As with any trauma history, the mechanism of injury is of utmost importance. The history and physical examination of these injuries are relatively simple. However, if there is a fracture with a cortical breach, it is termed a greenstick fracture if unicortical or a complete fracture if bicortical.īuckle fractures are incredibly common injuries that present to the emergency department, which are invariably always managed conservatively, and do not routinely require orthopedic input. The appearance on plain X-ray shows the fracture site as two outcroppings of bone, as though the long bone has collapsed or ‘buckled.’ The word "torus" is the Latin word "protuberance. ![]() In long bones, injuries without a cortical break either lead to plastic deformation through microfracture or to a ‘kink’ within the long bone, described as a ‘buckle’ or ‘torus’ fracture. With soft, malleable bone, and a thick protective periosteal covering, minor injuries can result in a spectrum of deformities with or without a cortical break. Two of the major differences include the presence of the physeal growth plate and a thicker periosteum with the softer underlying bone. The pediatric skeletal anatomy has unique properties that lead to varied pathology to that of the adult skeleton.
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