Torus Fracture

1. Pediatrics Case #8

2. History & Physical 7 YOM presents with R arm pain. Pt was playing outside 30 minutes PTA when he fell on an outstretched R arm. No head trauma or LOC. No other injuries. T 98.7 HR 119 BP 109/64 RR 21 Gen: WDWN, mild distress MSK: Pt holds RUE very still but has little TTP or swelling on exam. Mild TTP of distal forearm. FROM of fingers of R hand with active and passive ROM. R hand neurovascularly intact.

3. Images

4. Diagnosis: Torus Fracture Arrow shows a non-displaced torus fracture at the metaphyseal - diaphyseal j unction of the distal radius with no articular or growth plate involvement.

5. Pain Control Treatment consists of splinting with Ortho follow up in one wk , usually followed by a short arm cast for 3 wks for pt comfort and to prevent further injury. No reduction necessary. ED Management

6. Pediatric bone is more porous than adult bone, allowing it to bend, buckle, or deform, with actual fracture. Hence, torus fx is unique to pediatric pts . Also called a “Buckle” fracture Most common location is distal radius. O ccur at the diaphyseal-metaphyseal junction, where the transition from relatively porous to more dense bone predisposes to local failure when exposed to an axial load. It is important that x-ray be carefully examined to ascertain that tension side is intact. If fx is not on compression side then pt has greenstick fx , not a torus fx , & fx may proceed to deform in the cast. Pearls

7. Additional Images

8. Wheeless ' Textbook of Orthopaedics . Torus Fracture / Platic Deformation. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. Chapter 133: Musculoskeletal Disorders in Children http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/pediatrics/case13/ http://en.wikipedia.org/wiki/Greenstick_fracture http://medical-definitions.com/fracture/torus-fracture.htm References