Bent But Not Broken: Buckle Fractures Explained

Because their bones are softer and still growing, children can experience a type of fracture almost exclusive to pre-adolescence, called a buckle fracture or an incomplete fracture. Also called torus fractures, these injuries often happen when a child breaks their fall with their hands, resulting in a compression of the bones in the forearm. A buckle fracture is one of the most common and less severe types in pediatrics, but it still causes great pain and does require medical attention.

Child Bone Development

Young bones have some unique characteristics compared to adult’s. First, a child’s bones are growing, and so they are still flexible and quite resilient. This is why the bones often do not break in the conventional sense. Additionally, children’s bones are surrounded by a thick layer of connective tissue, the periosteum, which protects the bone from injury and harm so it can continue growing. The periosteum provides extra blood supply to help cells grow, especially when there is a fracture or injury. Therefore, children’s bones tend to heal much faster than people whose periosteum has thinned.

Overview of Buckle Fractures

A buckle fracture occurs when one side of the bone bends or buckles, but does not break or fracture completely. The bone is compressed with great force, causing a bulge but, overall, remains in position and does not separate. This is an incomplete and stable fracture. Left untreated, a buckle fracture may cause the child’s bone to grow in this curved, uneven shape, so it is vital to seek quick treatment, particularly because children’s bones begin the healing process quickly.

Types of Fractures

A buckle fracture is similar to a greenstick fracture, another common childhood injury. Unlike the former, a greenstick fracture does cause a crack on one side of the bone, but because the break does not go all the way through, the bone remains in one piece. Hairline fractures are also similar to buckle fractures. These are characterized by multiple tiny cracks, usually caused by repetitive stress and overuse, such as when dancing or running. A single, nondisplaced fracture is what people typically think of, in which the bone cracks or breaks all the way through, resulting in two separate pieces.

Demographics

Buckle fractures are most common in children between five and 10, though they can occur in toddlers as young as two. The bones in children of this age are still growing and flexible enough that they do not snap upon impact like a mature bone would. Teens and adults almost never experience buckle fractures, but the injury can occur in older adults with osteoporosis or those who participate in contact sports.

Causes of Buckle Fractures

Children are constantly active — running, jumping, climbing, swinging, dancing, playing sports, and, of course, stumbling and falling. Many children instinctively extend their arms to catch themselves when they fall, and the resulting impact and stress on the bone can cause a buckle fracture. Forty to fifty percent of broken bones in children are forearm fractures. Of these, 50% are buckle fractures, with three-quarters of them occurring at the wrist. The injury can also occur in the leg, often when a child lands on their feet after jumping from a considerable height.

Symptoms

A child with a buckle fracture will be in immense pain and also likely experience swelling and inflammation, bruising, and tenderness. In some cases, a bend or curve in the limb may be visible, but most of the time, there is no deformity. The injured child will have difficulty moving the limb, particularly rotating the forearm and may notice numbness in the hand or forearm if the fracture causes nerve damage.

Diagnosing Buckle Fractures

Doctors use standard x-rays to diagnose or confirm buckle fractures, rule out any more severe injury, and identify the precise location of the fracture. It is important to seek medical help right away with buckle fractures. Because a child’s bones quickly go into healing mode, early diagnosis and treatment will prevent abnormalities during the healing process that could cause life-long issues.

Treatment

Whenever a child has a possible buckle fracture, it is vital to keep the arm or leg immobilized as much as possible. Parents may want to create a splint or sling until they see a doctor, and the limb should be raised above heart level to prevent swelling. Initially, the doctor may place the bone in a splint until the swelling subsides. Once the inflammation decreases, the child may require a plaster or fiberglass cast to keep the limb immobilized and ensure it heals properly. However, recent studies show that kids who wear a removable splint function better than those who receive a short arm cast.

Recovery

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help a child deal with the initial pain and swelling of a buckle fracture. Children under four years old may only need a cast for three weeks or so, while older children may require one for four to six weeks. Parents should ensure the child avoids any activities that use the limb for at least two weeks, to avoid re-injury. Most younger children are back to normal after four to six weeks. In some cases, buckle fractures cause a bone to heal crooked, but at this age, there is plenty of time for the bone to remodel itself and straighten out.

Follow-Up

After healing from a buckle fracture, most doctors recommend a follow-up visit. If symptoms continue beyond six weeks, the child may need to see an orthopedic surgeon. The following symptoms could indicate an issue and parents should talk to a doctor immediately if they notice or their child complains of

• worsening of pain even after rest, ice, and medicine
• numbness in the extremities
• cold, pale, and swollen skin over the fractured area
• inability to move fingers or toes
• damage to or breakage of the cast or splint
• unpleasant odor or discharge from the cast