100 Greenstick Torus Fracture

CASE 100

Greenstick Torus Fracture

Peter L. Munk, Anthony G.Ryan, and Laurel O. Marchinkow

Clinical Presentation

A 5-year-old boy, having fallen from a chair, presented with pain, swelling, and reduced movement of his right arm.

Figure 100A

Figure 100B

Anteroposterior (AP) (Fig. 100A) and lateral (Fig. 100B) images of the wrist show an incomplete fracture of the distal radius affecting the ulnar and volar aspects of the bone; however, the dorsal and radial aspects of the cortex are not breached.

Diagnosis

Greenstick fracture of the distal radius.

Differential Diagnosis

None.

Discussion

Background

The combination of Salter-Harris and greenstick fractures accounts for the vast majority of fractures seen in the pediatric population.

Etiology

Trauma resulting in axial or “bending” forces accounts for greenstick fractures.
Longitudinally oriented forces are frequently responsible for torus fractures; hence their alternative title “buckle” fractures.

Pathophysiology

The pediatric skeleton is far more plastic than the adult, frequently resulting in incomplete fractures due to the deformability of the immature bones. Several types of incomplete fractures are commonly encountered. Notable are two principal types of fractures that typically affect long bones, particularly in the upper extremity: greenstick and torus.

Clinical Findings

These fractures are essentially confined to the pediatric population, and a typical history of fall followed by immediate pain and swelling is usually given.

Complications

Rarely, malunion
Posttraumatic cortical defect at the site of the cortical break
Even when fractures heal in a malaligned fashion, they are rarely refractured, given the propensity for the bones to realign with growth.