Paeds Trauma iSAWE 17

Question

A 6 year old boy falls while running and has a sore wrist.

Paeds Trauma iSAWE 17, AP and lateral radiographs of the wrist
AP and lateral radiographs of the wrist. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 4.0.
  1. Describe the radiographs.
  2. How does this injury differ from a greenstick fracture?
  3. What is the evidence for treatment?

Answer

Radiographs

  • Buckling (torus fracture) of the distal radial metaphyseal cortex
  • No break in the opposite cortex

Buckle versus greenstick

FeatureBuckle (torus)Greenstick
MechanismAxial compressionBending
CortexCompression side buckles, tension side intactTension side breaks, compression side bends
StabilityStableCan angulate further
TreatmentSplint or bandageCast, reduce if angulated

Evidence

  • FORCE trial (2022) showed a bandage and immediate discharge gave equivalent pain at 3 days
  • No routine follow up or repeat radiographs needed
  • Removable splint for comfort for about 3 weeks
  • Return if pain persists or deformity develops
  • Distinguish from greenstick and Salter-Harris fractures, which need more care

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.