Contributor: Aaron Lessen, MD

Educational Pearls:

Torus (Buckle) fractures are a commonly encountered pediatric fracture pattern

Typically presents as wrist pain secondary to a child falling on outstretched hand
One edge of the bone "buckles" or bends because children's bones are softer and more pliable

Management

Older studies have shown that short term immobilization with a velcro splint and primary care follow up is sufficient
Recent randomized trial compared immobilization with Velcro splint with as needed wrist support using a gauze wrap
No significant differences noted in outcomes between the two cohorts

Physicians can consider using an ace or gauze wrap as needed for buckle fracture management along with OTC analgesics for pain management

References

Asokan A, Kheir N. Pediatric Torus Buckle Fracture. StatPearls. StatPearls Publishing

Kennedy SA, Slobogean GP, Mulpuri K. Does degree of immobilization influence refracture rate in the forearm buckle fracture? J Pediatr Orthop B. Jan 2010;19(1):77-81. doi:10.1097/BPB.0b013e32832f067a

Perry DC, Achten J, Knight R, et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet. Jul 2 2022;400(10345):39-47. doi:10.1016/s0140-6736(22)01015-7

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD

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