Torus (Buckle) Fracture: Understanding Causes, Symptoms, Diagnosis, and Treatment

Introduction

Fractures, or broken bones, are common injuries that can occur due to various causes. One type of fracture that frequently affects children and adolescents is the torus fracture, also known as a buckle fracture. This type of fracture may not be as widely recognized as traditional fractures, but understanding its causes, symptoms, and treatment is essential for both medical professionals and parents alike.

What Is a Torus (Buckle) Fracture?

A torus fracture, often referred to as a buckle fracture, is a specific type of incomplete fracture commonly seen in pediatric patients. Unlike complete fractures, where the bone breaks into two or more separate pieces, a buckle fracture occurs when the bone's outer cortex (the hard, dense layer) compresses or buckles due to force without causing the inner cortex to break. This results in a raised or bulging area on the surface of the bone, resembling the shape of a torus or a bump. The most commonly affected bones in torus fractures are the forearm bones, specifically the radius (the larger bone in the forearm) and the ulna (the smaller bone in the forearm).

What Are the Causes of Torus (Buckle) Fractures?

• Direct Impact: Torus fractures commonly occur when a child falls onto an outstretched hand or an extended limb, transmitting force along the bone. This direct impact leads to localized compression of the bone's cortex, causing it to buckle.

• Play and Sports Injuries: Children frequently engage in vigorous physical activities and sports. Sudden stops, falls, or collisions during play can generate sufficient force to cause a torus fracture. Sports like skateboarding, biking, and soccer are common culprits.

• Accidental Falls: Children's exploratory nature can result in falls from heights, such as playground equipment or furniture, leading to torus fractures. Their bones are more elastic and less brittle, making them prone to buckle rather than completely break.

• Twisting Forces: Sometimes, a twisting force applied to a limb can generate enough pressure on one side of the bone, causing it to buckle on the opposite side. This mechanism is common in fractures involving the forearm.

• Low Bone Density: In some cases, underlying conditions or nutritional deficiencies can contribute to decreased bone density, making bones more susceptible to torus fractures even with minor impacts.

What Are the Symptoms of Torus (Buckle) Fractures?

1. Localized Pain: One of the primary symptoms of a torus fracture is localized pain at the site of the injury. Children may experience mild to moderate pain, which can be exacerbated by movement or when pressure is applied to the affected area.

2. Swelling: Swelling is a common response to any bone injury, including torus fractures. The body's natural inflammatory reaction leads to swelling around the fractured area. However, the swelling associated with torus fractures may be less pronounced compared to more severe fractures.

3. Visible Deformity: Perhaps the most characteristic feature of torus fractures is the visible deformity or bump that forms at the fracture site. This deformity results from the bone compressing on one side and creating a noticeable elevation on the bone's surface.

4. Limited Movement: Children with torus fractures might experience a limited range of motion in the affected limb due to the discomfort and pain caused by the fracture. They might be hesitant to move the injured limb due to these sensations.

5. Tenderness: Tenderness is a hallmark symptom of torus fractures. The area surrounding the fracture site is often tender to the touch, and children may express discomfort or pain when pressure is applied to this area.

6. Mild Redness or Bruising: Some redness or minor bruising may be present around the injured area due to the trauma that led to the fracture. While not as prominent as in more severe fractures, this discoloration can be a visual indicator of the injury.

How to Diagnose Torus (Buckle) Fractures?

• Physical Examination: The doctor will perform a physical examination to assess the injured area. They will examine for indications of inflammation, sensitivity, distortion, and any observable indications of injury.

• Patient History: The doctor will ask questions about how the injury occurred, the location of the pain, and any other relevant information. This can help them understand the nature of the injury and its potential severity.

• X-rays: X-rays are commonly used to diagnose torus fractures. X-ray images can provide a clear view of the bone and help determine if there is any buckling or bulging on one side of the bone. Torus fractures may appear as a bulge or bump on one side of the bone.

• Ultrasound (Optional): In some cases, ultrasound might be used, especially for young children or when X-ray exposure needs to be minimized. Ultrasound can help visualize the bone and detect any irregularities.

• Clinical Judgment: Sometimes, torus fractures can be subtle and might not show up clearly on initial X-rays. In such cases, the doctor's clinical judgment, based on physical examination and patient history, is crucial for accurate diagnosis and appropriate treatment.

• Follow-up Imaging (Optional): If the initial X-rays are inconclusive, but the doctor still suspects a torus fracture, they might recommend follow-up imaging after a few days. This can help monitor any changes in the bone's appearance as healing progresses.

What Are the Treatments of Torus (Buckle) Fractures?

• Casting or Splinting: In many cases, a simple cast or splint may be applied to stabilize the affected bone and prevent movement. This helps the bone heal properly while minimizing the risk of further injury.

• Closed Reduction: If the fracture is displaced or if the bone alignment needs to be corrected, a doctor may perform a closed reduction. This involves gently manipulating the bone fragments back into their proper position without surgery.

• Immobilization: After the bone is properly aligned, a cast, splint, or brace may be used to immobilize the area for a period of several weeks to allow for healing. The choice of immobilization depends on the location and severity of the fracture.

• Pain Management: During the recovery period, it might be advised to use over-the-counter pain relievers such as Acetaminophen or Ibuprofen to help control pain and alleviate discomfort.

• Activity Restrictions: Patients may be advised to restrict certain activities that could put stress on the healing bone. By doing so, the risk of exacerbating the injury can be reduced, and the process of appropriate healing can be facilitated.

• Follow-up and Monitoring: Regular follow-up appointments with a healthcare provider are important to monitor the healing progress and make any necessary adjustments to the treatment plan.

• Physical Therapy: Once the cast or splint is removed, certain individuals might find physical therapy advantageous in recovering muscle strength, flexibility, and the ability to move the affected limb within a desired range.

• Weight-Bearing Guidance: If the fracture occurs in a weight-bearing bone like the tibia, patients may receive guidance on when it's safe to start putting weight on the affected limb again.

Conclusion

In conclusion, a Torus (buckle) fracture, though commonly considered a minor pediatric injury, demands careful evaluation and management to ensure optimal recovery and prevent potential complications. Its distinct mechanism of injury, characterized by axial compression forces, results in the unique buckling of the cortex. While typically stable, proper diagnosis through clinical examination and imaging remains crucial to rule out associated injuries. Treatment approaches, often non-surgical, center around pain management, immobilization, and close monitoring of the fracture's healing progress. Timely intervention and adherence to recommended protocols are vital to prevent malunion or growth disturbances, particularly in the growing pediatric population. As medical understanding continues to evolve, healthcare practitioners must stay abreast of the latest research to consistently deliver effective care and promote the well-being of young patients affected by Torus fractures.