A 7-year-old male presented with pain after falling on an outstretched hand.
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Diagnosis: Torus fracture
FindingRadiograph of the forearm shows subtle buckling involving the lateral cortex of the radius in its metaphysis (arrow in Figure 2).
• Torus fracture is a type of incomplete fracture
• Commonly seen in long bones of pediatric patients.1,2
• Most common mechanism of injury is indirect trauma, like fall on an outstretched hand (FOOSH).1,3
• Axial load causes trabecular compression resulting in cortical buckling without an obvious fracture line.4
• Elasticity of the developing bones in children causes buckling of the cortex rather than a fracture along a single plane as in adults.2,3
Imaging FeaturesOn radiographs:
• Seen as a curved disruption of the cortex and periosteum along the convex aspect of the bone along the metaphysis of long bones, most commonly distal radius.2• Best seen when bone is imaged in profile as opposed to en face.2
• Can be associated with mild overlying soft tissue.
• Fracture line can be indistinct.
• Usually self-limiting.
• Rest and immobilization in the form a splint suffices in most cases.1
• If the angulation is significant, manipulation may be needed.1
• Occur when the force applied to a bone is sufficient to overcome the integrity of the cortex resulting in fracture of the convex surface and bucking of the concave surface.4
• Commonly seen in the diaphysis.4
• Needs active management and can take a long time to heal as they tend to occur in the diaphysis which are relatively slowly growing portions of the bone.5
1. Solan MC, Rees R, Daly K. Current management of torus fractures of the distal radius. Injury. 2002;33:503-505.
2. Uzelac A, Davis R. Blueprints Radiology. LWW. ISBN:1405104600.
3. Trauma X-ray - Upper limb gallery 1 - Greenstick and Torus fractures [Internet]. Radiologymasterclass.co.uk. 2017 [cited 6 August 2017]. Available from: http://www.radiologymasterclass.co.uk/gallery/trauma/x-ray_arm_1/fractur...
4. Weerakkody Y. Torus fracture | Radiology Reference Article | Radiopaedia.org [Internet]. Radiopaedia.org. 2017 [cited 6 August 2017]. Available from: https://radiopaedia.org/articles/torus-fracture-1
5. The Radiology Assistant : Wrist - Fractures [Internet]. Radiologyassistant.nl. 2017 [cited 6 August 2017]. Available from: http://www.radiologyassistant.nl/en/p476a23436683b/wrist-fractures.html
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