Buckle Fractures

Etiology and Mechanism of Injury

• Caused by compression injury leading to bulging or ‘buckling’ of the bone without complete break.
• Commonly results from axial loading, such as falling on an outstretched hand.
• Distal radius is the most frequent site.
• Pediatric bones can absorb impact and bend, contributing to higher prevalence.

Epidemiology

• Significant portion of pediatric fractures.
• Most common in children aged 7 to 12 years.

Clinical Presentation and Physical Examination

• History of fall or direct impact.
• Symptoms include swelling, tenderness, and visible deformity.
• Physical exam focuses on swelling and tenderness at the injury site.

Evaluation and Diagnosis

• Diagnosis via radiographic evaluation with two orthogonal plane X-rays.
• Characteristic buckling of the cortex seen on X-ray.
• Comparison with the contralateral limb may be used for assessment.

Management Strategies

• Immobilization with removable splints or casts for 2-3 weeks.
• Removable splints are favored for convenience and patient/parent satisfaction.
• Splints can be removed for showering but should be worn at other times, including sleep.
• Treatment aims for comfort and minimal disruption to daily activities while ensuring healing.

Differential Diagnosis

• Important to distinguish from:
  • Greenstick fractures
  • Salter-Harris fractures (involving growth plates)
  • Toddler’s fractures
  • Non-accidental injury

Sure, here’s a detailed table covering various types of fractures, their definitions, symptoms/signs, and potential complications:

Fracture Type	Definition	Symptoms/Signs	Complications
Buckle (Torus) Fracture	Incomplete fracture where one side of the bone bends, causing a buckle without breaking the other side	Pain, tenderness, and swelling at the site of injury; often occurs in distal radius	Minimal, usually heals well; rarely leads to deformity or functional loss
Greenstick Fracture	Incomplete fracture where one side of the bone breaks while the other side bends, common in children	Pain, swelling, and deformity at the fracture site; may cause decreased function in the affected limb	Potential for bone deformity if not properly treated; malunion
Salter-Harris Fractures	Fractures involving the growth plate (physis) in children, classified into five types based on severity Type I: Transverse fracture through the growth plate. Type II: Fracture through the growth plate and metaphysis. Type III: Fracture through the growth plate and epiphysis. Type IV: Fracture through the growth plate, metaphysis, and epiphysis. Type V: Compression fracture of the growth plate.	Pain, tenderness, and swelling around the growth plate; difficulty using the affected limb	Growth disturbances, deformities, arthritis, and chronic pain
Toddler’s Fracture	A non-displaced spiral fracture of the tibia, typically in children aged 1-3 years	Trivial incidents like a trip or fall, often involving a twisting mechanism Limping or refusal to bear weight on the affected leg; pain and tenderness over the tibia	Mx: CAM boot, short leg cast, or splint over long leg cast Generally heals well; may cause temporary mobility issues
Non-Accidental Injury (NAI)	Fractures resulting from physical abuse; multiple fractures at different healing stages or unusual fracture patterns	Varying symptoms depending on the injury; may include bruises, burns, or other signs of trauma	Long-term physical and psychological effects; potential for severe disability or death

Prognosis and Follow-up

• Excellent prognosis due to bone stability and periosteum’s healing role.
• Typically no need for X-ray or follow-up appointments post-initial treatment.
• Remove splint three weeks post-injury.
• Initial wrist stiffness and soreness are expected.
• Avoid rough play and contact sports for 6 weeks.

Complications and Patient Education

• Rare complications, including discomfort or minor skin issues.
• Removable splints have reduced complications.
• Educate parents on:
  • Proper splint care
  • Activity modifications
  • Monitoring for complications