Choosing Wisely:

Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer tender or painful.

Rationale and Comments: Buckle (torus) fractures are very common injuries in young children, especially in the distal radius. The fracture is one of compression, where the metaphyseal bone impacts on itself, and actually becomes denser. These fractures are inherently stable and do not necessarily require a formal cast, unless severe pain or fracture instability necessitates a cast for four weeks. Instead immobilization with a simple wrist brace or removable splint is often preferable. The mild cortical angular deformity reliably remodels over time and requires no intervention or monitoring. If the fracture is non-tender to palpation at four weeks post-injury, no follow-up radiograph is required, and full activities may be resumed.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North America
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Orthopedic
  • Pediatric
  • References: • Symons S. Rowsell M, Bhowal B, Diass JJ. Hospital versus home management of children with buckle factures of the distal radius: A prospective randomized trial. J Bone Joint Surg Br. 2001;83:556-560.
    • Van Bosse HJ, Patel RJ, Thacker M, Sala DA. Minimalistic approach to treating wrist torus fractures. J Pediatric Orthop. 2005;25(4):495-500.
    • Williams KG, Smith G, Luhmann SJ, Mao J, Gunn JD, Luhmann JD. A randomized controlled trial of cast versus splint for distal radial buckle fracture: An evaluation of satisfaction, convenience, and preference. Pediatric Emergency Care. 2013;29(5):555-559.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now