Buckle fracture versus greenstick fractures introduction Buckle and greenstick fractures are common pediatric bone injuries characterized by incomplete breaks that often result from low-impact trauma.
Buckle fracture versus greenstick fractures introduction Buckle and greenstick fractures are common pediatric bone injuries characterized by incomplete breaks that often result from low-impact trauma. With football and soccer season upon us, the incidence of pediatric forearm fractures will normally increase. Sports medicine providers may need to evaluate FOOSH (fall on outstretched hand) injuries and should be comfortable with the differences between the adult forearm and the pediatric forearm.
The provider should also be aware of potential pitfalls and fractures that may require surgery. The pediatric skeletal anatomy has unique properties that lead to varied pathology to that of the adult skeleton. Two of the major differences include the presence of the physeal growth plate and a thicker periosteum with the softer underlying bone.
With soft, malleable bone, and a thick protective periosteal covering, minor injuries can result in a spectrum of deformities with or without a cortical break. In long bones, injuries without a cortical break either lead to plastic deformation through microfracture or to a ‘kink’ within the long bone, described as a ‘buckle’ or ‘torus’ fracture. The mechanism of injury for buckle fractures is usually axial loading of the meta-diaphyseal junction of skeletally immature long bones.
This transition point is susceptible to failure due to the different biomechanical characteristics of the two types of bone: developing woven bone of the metaphysis and tough lamellar bone of the diaphysis. When axial loads surpass the plastic deformation threshold, trabeculae fail and cause the cortex to bulge outwards at the apex of the compressive forces. Buckle fractures are usually specific to children because their bone has a lower ash content (less hydroxyapatite) and is more likely to absorb force and experience plastic deformation.
Additionally, children have a thick periosteal sleeve above the cortex that typically stays intact and prevents unrestrained fracture extension and complete bone failure. These differ to greenstick fractures, in which the bone bends (rather than crushes) resulting in a complete break in one cortex and a bend on the opposite side (akin to snapping a fresh twig from a tree). The appearance on plain X-ray for buckle fractures shows the fracture site as two outcroppings of bone, as though the long bone has collapsed or ‘buckled.’ This appearance also resembles the horns of a bull viewed head-on, hence the alternative nomenclature – ‘torus’ fracture.
If you are experiencing symptoms that may be related to buckle and greenstick fractures of the distal radius, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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