ACR Codes: 4.4
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.
Reference(s): Bone and Joint Imaging, 2nd edition, 1996, Donald Resnick M.D
Pediatric Radiology: The Requisites, 2nd edition, 1998, Hans Blickman M.D.
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Disease Topic 4149 
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