Is a buckle fracture of the distal radius (radial bone) and ulna (ulnar bone) considered a type of wrist fracture?

Buckle Fracture of Distal Radius and Ulna is a Wrist Fracture

Yes, a buckle fracture of the distal radius and ulna is considered a type of wrist fracture. Distal radius fractures are among the most common fractures in the upper extremity, and buckle (torus) fractures represent a specific subtype that occurs at the wrist joint 1, 2.

Anatomical Classification

• Distal radius fractures account for up to 18% of fractures in the elderly population, with the incidence increasing due to osteoporosis 1
• Buckle fractures are incomplete compression fractures without cortical disruption that commonly occur in the metaphyseal region of the distal radius and/or ulna 2, 3
• These fractures occur at the junction of the distal radius/ulna and the wrist joint, placing them anatomically within the wrist region 1, 2

Diagnostic Considerations

• Initial evaluation of suspected wrist fractures, including buckle fractures, requires proper radiographic imaging 1
• A 3-view examination of the wrist (posteroanterior, lateral, and 45° semipronated oblique view) is recommended for suspected distal radius fractures 1
• Some studies suggest that a fourth projection (semisupinated oblique) may increase diagnostic yield for distal radius fractures 1
• If initial imaging is negative but clinical suspicion remains high, splinting and repeat radiography in 7-14 days is recommended 2

Age-Related Considerations

• Buckle fractures are most commonly seen in children but can occasionally occur in adults 2, 4
• In children aged 12-23 months with a distal radius/ulna buckle fracture from a reported fall while cruising or walking, a skeletal survey is generally not necessary 1
• Adult cases of distal radial torus (buckle) fractures are rare but have been reported and should be considered in the differential diagnosis of wrist sprain 4

Treatment Approaches

• Buckle fractures are inherently stable with low risk for displacement, allowing for various treatment options 5, 3
• Treatment options include:
  • Removable splints (worn for approximately 3 weeks) 3
  • Short-arm casts (minimum of 3 weeks for adults with nondisplaced or minimally displaced distal radius fractures) 2
  • Soft bandaging in some cases 5
• Recent evidence supports the use of removable splints over casting for distal radial buckle fractures, with higher levels of patient satisfaction, preference, and convenience 5, 3

Associated Injuries and Complications

• Distal radius fractures may be associated with ulnar styloid fractures, which can be predictive of poorer outcomes 6
• Median nerve injury can be a complication of distal radius fractures 2
• When evaluating distal radius fractures, a true lateral radiograph of the carpus is recommended to assess distal radioulnar joint alignment 1

Clinical Implications

• Proper identification and classification of buckle fractures at the wrist is important for appropriate management 2, 3
• For most patients with trauma to the hand and wrist, conventional radiographs provide sufficient diagnostic information 1
• Successful treatment requires understanding the stability of the fracture pattern, with buckle fractures being considered stable injuries 2, 5

In conclusion, buckle fractures of the distal radius and ulna are definitively classified as wrist fractures, representing a specific subtype that typically has a favorable prognosis due to their inherent stability 2, 3.