These are inherently stable injuries and almost never require any further intervention. Treatment goals in buckle fractures are for patient comfort and parental reassurance. Thus, as a rule of thumb, always assess for injuries in joints above and below the fracture site. For example, an associated injury to a distal radius buckle fracture could be supracondylar fractures or radial head fractures/dislocations. If there is a suspicion of plastic deformation, one might obtain an X-ray of the contralateral limb for comparison.Īdditionally, depending on the mechanism of injury and symptoms, one may also require radiographs more proximally to assess for any associated injury. Also, there may be a plastic deformation of an associated bone – e.g., the ulna in distal radius fractures. Typical X-ray findings would include buckling out of one or both cortexes in a long bone, with or without deformity. Two plain radiographs in two orthogonal planes are required to assess the fracture site for any cortical breach and level of deformity. 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. These injuries occur throughout the pediatric age range but are particularly common between the ages of 7 to 12 years old. Specifically, 50% of pediatric wrist fractures are buckle fractures. 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. Of all pediatric injuries, fractures constitute around 25% of hospital attendance. The mechanism of injury is by axial loading, which frequently occurs due to falling on an outstretched arm. The distal radius is among the most commonly broken bones during childhood. Etiologyīuckle fractures occur almost exclusively in long bones of children, although they can also occur in flat bones - particularly rib fractures. 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. Explain how to counsel a patient with a buckle fracture.Identify reasons for delayed diagnosis of buckle fractures.Describe imaging findings associated with buckle fractures.Summarize the management considerations for patients with buckle fractures.This activity outlines the evaluation and management of pediatric buckle fractures and reviews the role of the healthcare team in managing patients with this condition. Buckle fractures are incredibly common injuries that present to the emergency department, which are invariably always managed conservatively, and do not routinely require orthopedic input.
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