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Case of the Week - Patient Summary 8695
Peer Reviewed and Certified -

Approved by: Albert V Porambo - 2005-11-01 08:03:59-05

Demographics: 6 y.o. girl

History & Chief complaint:

a 6 year old girl fell out of tree, now she has pain in her left wrist.

Physical exam and Laboratory:

• Pain and swelling over left forearm.

Summary of Findings:

Radiographs of the left wrist demonstrate two fractures:
• a Torus (buckle) fracture of the distal ulna. There is radial angulation of the distal portion of the ulnar Torus (buckle) fracture.

• a Greenstick fracture of the distal radial diaphasis, with anterior angulation of the distal radius.

Differential Diagnosis:

Fracture

Diagnosis:

Torus (Buckle) Fracture and Greenstick Fracture

Confirmed by: Radiographs and Clinical

Treatment and Followup:

Orthopedic consult and casting of fracture.

Patient Specific Discussion: (Also Read the Disease Discussion)

See Factoid

Disease Discussion - Torus (Buckle) Fracture
Discussion Author: Matthew J Hoffman

In the immature skeleton the bones are more pliable. This is partly due to more Haversian Canals within a greater percentage of the cortex and partly due to less complete mineralization of immature cortical bone. This also explains why children have more incomplete fractures than adults.

Examples of incomplete fracture types include:
» Torus (buckle) Fracture, which results from a force insufficient enough to produce complete cortical discontinuity but instead cause a buckling of the cortex (this is a plastic bending of the bone, which causes deformation of the bone). Torus fractures may occur on the opposite side of a Greenstick fracture (a greenstick fracture is one wherein only one side of the bone has a true linear fracture lucency, but the fracture line does not continue across the entirety of the bone. Torus fractures most commonly occur in the metaphyseal and diametaphyseal regions.

» Greenstick Fracture: Fracture of only one side of the cortex. Fracture is on the convex side with a "bend" on the concave side.

» Bowing (plastic) Type: A plastic response to a longitudinal stress in a bone. There is no obvious break in the cortex.

Case and/or Image Source: Mark D Travis
Submitted by: Mark D Travis -

Affiliation: National Naval Medical Center Bethesda

Approved By: Albert V Porambo -

Affiliation: Civilian Medical Center

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