What is a torus fracture?

Torus Fracture: Definition and Management

A torus fracture, also known as a buckle fracture, is a stable injury that occurs when compressive forces cause axial loading along the length of the bone, resulting in buckling of one cortex while the opposite cortex remains intact. These fractures are inherently stable with low risk for displacement and typically heal well with minimal intervention. 1, 2

Mechanism and Characteristics

• Torus fractures result from compression from axial loading along the length of the bone, commonly occurring during short falls (from heights between 6 inches and 4 feet) 1, 2
• Most frequently seen in the distal radius of children, but can occur in other long bones 2, 3
• The fracture involves buckling of one cortex (typically the dorsal cortex in distal radius fractures) while the opposite cortex remains intact 4
• These fractures are inherently stable due to the intact cortex on the opposite side 3, 4

Diagnosis

• Radiographic imaging is the standard diagnostic tool for identifying torus fractures 1
• CT imaging has higher sensitivity (94-100%) compared to plain radiographs for detecting fractures, but is usually not necessary for simple torus fractures 1
• The characteristic appearance on X-ray is a buckle or bulge in the cortex without complete disruption 3

Management

• Current evidence supports the use of removable splints rather than circumferential casts for torus fractures 3, 4, 5
• Immobilization should typically be maintained for approximately 3 weeks 3, 6
• Studies have demonstrated equivalent pain control at 3 days between bandage/splint treatment and rigid immobilization 5
• Removable splints offer several advantages over traditional casting:
  • Allow for better hygiene 6, 7
  • Enable earlier return to normal function 7
  • Preferred by parents and patients 6, 7
  • More cost-effective for healthcare systems 3, 4, 6
• Follow-up appointments and repeat radiological imaging are generally unnecessary once adequate information is provided at the time of diagnosis 3, 4

Special Considerations in Pediatric Patients

• In children under 12 months with fractures, including torus fractures, clinicians should consider the possibility of non-accidental injury 2
• For children 9-11 months old with distal radius/ulna torus fractures with a reported fall while cruising or walking, skeletal survey may not be necessary 2
• For children 12-23 months old with distal radius/ulna torus fractures, skeletal survey is generally considered inappropriate 2

Clinical Pitfalls and Caveats

• Torus fractures are often over-treated with unnecessary casting, follow-up visits, and repeat imaging 3, 4
• Failure to distinguish between torus fractures and other fracture types may lead to inappropriate management 1
• While torus fractures are inherently stable, they should not be confused with complete fractures or those with displacement, which may require more aggressive management 1
• Despite evidence supporting simpler management approaches, practice patterns vary widely and often conflict with the evidence base 3, 4