Pediatric Torus Buckle Fracture

The pediatric skeletal anatomy has unique properties that lead to varied pathology to that of the adult skeleton. Two of the major differences include the presence of the physeal growth plate and a thicker periosteum with the softer underlying bone. 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. 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.The appearance on plain X-ray shows the fracture site as two outcroppings of bone, as though the long bone has collapsed or ‘buckled.’ This appearance also resembles the horns of a bull viewed head-on, hence the alternative nomenclature – ‘torus’ fracture. However, if there is a fracture with a cortical breach, it is termed a greenstick fracture if unicortical, or a complete fracture if bicortical.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.