A buckle fracture in the wrist is a common injury, particularly among children, often resulting from a fall onto an outstretched hand. This type of fracture, also known as a torus fracture, involves a compression of the bone rather than a complete break.
What is a Buckle Fracture?
A buckle fracture, also known as a torus fracture, is an incomplete break in a bone where the outer layer is compressed, causing it to bulge or “buckle” rather than snapping completely. This type of injury is distinct from a full fracture because the bone does not separate into two pieces. It is highly prevalent in children, especially those under 12, due to their bones being softer and more flexible than adult bones.
These fractures commonly affect the long bones of the forearm, specifically the radius or ulna, near the wrist joint. The injury typically occurs when a child falls and instinctively extends their hand to brace themselves, transmitting axial force along the bone. This compressive force leads to the characteristic bulging effect on one side of the bone, while the other side remains intact. Unlike more severe fractures, buckle fractures are considered stable injuries because the bone does not move out of alignment.
How Buckle Fractures Are Diagnosed
The diagnosis of a buckle fracture typically begins with a physical examination and a review of the circumstances surrounding the injury. Common symptoms that may prompt a visit to a healthcare provider include immediate pain, tenderness to the touch, and mild swelling around the wrist. The injured wrist may also exhibit limited movement, particularly when rotating the arm or flexing the hand. Importantly, there is usually no visible deformity, meaning the wrist retains its normal shape.
To confirm a buckle fracture, healthcare providers typically order X-rays of the affected wrist. While the fracture may be subtle, it appears as a small bulge or protuberance on the side of the bone in the X-ray images. X-rays typically provide sufficient information for an accurate diagnosis, eliminating the need for more complex imaging studies.
Standard Treatment for Buckle Fractures
Treatment for buckle fractures is generally non-surgical, focusing on immobilizing the injured wrist to allow the bone to heal naturally. The primary goal of immobilization is to reduce pain and protect the bone from further injury while it mends. A common method involves using a removable splint, which offers support and protection without the rigidity of a full cast. These splints are often made from low-temperature plastic with Velcro straps, allowing for easy removal for hygiene purposes like bathing or showering.
For some cases, such as concerns about compliance with a removable splint or greater activity levels, a short arm cast or a fiberglass cast may be used. While casts offer robust immobilization, removable splints provide comparable healing outcomes and can lead to better physical function, as they interfere less with daily activities. The duration of immobilization typically ranges from 3 to 4 weeks, though some may wear it for 2 to 3 weeks depending on the injury’s healing progress and the individual’s age.
Pain management is also an important aspect of treatment. Over-the-counter pain relievers such as acetaminophen or ibuprofen are usually sufficient to manage discomfort, especially in the first few days after the injury. Applying ice to the injured area for 15 to 20 minutes at a time can help reduce swelling and pain. Elevating the arm above heart level can also help minimize swelling and support the injured limb.
Navigating Recovery and Follow-Up
The recovery period for a buckle fracture is typically short, with most healing occurring within 3 to 6 weeks. During this time, the bone gradually strengthens, and discomfort subsides. After the immobilization device is removed, the wrist may feel stiff or slightly sore initially due to disuse, but this usually resolves within a few days to a couple of weeks with gentle movement.
Follow-up appointments are not always necessary for buckle fractures. However, some healthcare providers may recommend a follow-up visit within a few weeks to ensure proper healing and provide guidance on returning to activities. Repeat X-rays are generally not required unless there are specific concerns about healing or if pain persists.
During the recovery phase, it is advisable to avoid strenuous activities or sports that could place stress on the healing wrist. Activities involving impact, rough play, or a risk of falling should be avoided for approximately 6 weeks after the initial injury or until symptoms have fully resolved. Gradual return to normal activities is encouraged, with full participation in sports usually possible within a month or two, depending on the individual’s comfort and the healthcare provider’s recommendations. Physical therapy is typically not needed for buckle fractures because they heal well without long-term complications or weakness.