Distal Radius Buckle (Torus) Fracture

What is a torus fracture?

A torus or buckle fracture is a particular pattern of fracture seen in children. The bones in growing children are softer and more flexible than adult bones, and instead of breaking cleanly through, they sometimes buckle on one side — a bit like crushing one end of a drinks can.

The most common location is the wrist, just above the joint. Torus fractures are typically caused by falls onto an outstretched hand — one of the most common childhood injuries.

The reassuring thing is that torus fractures are stable injuries. The bone hasn't broken all the way through, and they heal predictably with appropriate support.

What does it feel like?

Children with torus fractures are usually clearly hurt but not as dramatically affected as with more serious injuries. Common features include:

• Pain at the wrist after a fall

• Some swelling around the wrist

• Reluctance to use the hand

• Tenderness when pressing on the bone

• Usually no obvious deformity (the bone hasn't displaced)

Pain often settles fairly quickly with the wrist supported, and the child returns to normal activity well before full bone healing has completed.

How is it diagnosed?

X-rays confirm the diagnosis and characterise the fracture pattern. Torus fractures have a typical appearance — the buckle is usually visible on at least one view.

Examination establishes the level of pain and excludes other injuries. It's worth being thorough because more significant fractures, or injuries to neighbouring bones, sometimes coexist or can be mistaken for a buckle fracture.

Modern practice has moved towards simpler treatment for these injuries because evidence has shown that aggressive immobilisation isn't necessary.

What are the treatment options?

Most torus fractures are now managed with a removable wrist splint rather than a full plaster cast. The splint is worn for around three weeks and the child gradually returns to activity as comfort allows.

Repeat X-rays during the healing period are often not needed for these fractures, since they're stable and the recovery is so reliable. Surgery is essentially never required for a true torus fracture. Nev will confirm what's right for your child at your consultation.

When should you get it checked?

Seek a specialist assessment if:

• Your child has wrist pain after a fall that isn't settling

• There's persistent swelling or tenderness over the bone

• Your child won't use the hand normally

• You've been told there's a fracture and want to confirm the right plan

• There's any change in the wrist's shape or movement

Torus fractures are common, well understood and reliably treated. The main thing is making sure the diagnosis is right and the treatment is matched appropriately.