Intended for healthcare professionals

Practice Uncertainties

What level of immobilisation is necessary for treatment of torus (buckle) fractures of the distal radius in children?

BMJ 2021; 372 doi: (Published 07 January 2021) Cite this as: BMJ 2021;372:m4862
  1. Daniel C Perry, associate professor in orthopaedic surgery, consultant orthopaedic surgeon1 22,
  2. Phoebe Gibson, parent representative3,
  3. Damian Roland, consultant in paediatric emergency medicine4,
  4. Shrouk Messahel, consultant in paediatric emergency medicine2
  1. 1Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  2. 2Alder Hey Children’s Hospital, Liverpool, UK
  3. 3Alder Hey Clinical Research Facility Parent Carer Forum, Liverpool, UK
  4. 4University Hospitals of Leicester, Leicester, UK
  1. Correspondence to D Perry daniel.perry{at}

What you need to know

  • Evidence suggests that most children with torus fractures of the distal radius make a full recovery within six weeks with no serious problems (including repeat injury) when treated with simple splints

  • Splint immobilisation and immediate discharge are recommended in guidelines, such as those from the National Institute for Health and Care Excellence (NICE), however the scientific quality of evidence underpinning the guidelines is rated low or very low

  • Health professionals may consider bandage treatment or even no treatment in the management of this injury, though the safety and acceptability of this approach to patients are not yet known

Torus (buckle) fractures are the most common fractures of the wrist in children, involving the distal radius and/or ulna bone (fig 1).1 They typically occur in children up to age 14, usually after a low energy fall.2 The flexibility of immature bone in children enables force to be absorbed as with the “crumple zone” of a car: crushing—or buckling—as it is injured. Such fractures differ from 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). Torus fractures result in a mild deformity without a break in the bone surface, and pain is the main clinical feature. The child may need assistance with schoolwork, time off physical activities, and help with self-care during the recovery period.

Fig 1

Anteroposterior (a) and lateral (b) radiographs of the wrist showing a torus fracture of the distal radius and ulna with compression of the bones dorsally, though no break in the bone surface

Parents typically expect that any fracture needs plaster cast immobilisation to ensure adequate healing. However, torus fractures heal quickly, with pain almost completely resolved three weeks after …

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