Figure 1
AP view of left forearm
Clinical History
Fall onto outstretched hand.
Imaging Findings
The patient presented after a fall onto their outstretched hand.
AP and lateral x-rays of the left hand were performed. A subtle deformity was seen at the distal metaphysis of the radius on the AP view. A slight bump was seen along the dorsal cortex of the radius distorting the normal curvature of the cortex. The diagnosis of a torus (buckle) fracture was made.
Discussion
Torus fracture is probably the most common fracture involving the distal forearm in children between the ages 6 and 10 years. The word "torus" is Latin and means a protuberance, a bulge. In architecture, a torus is the bulge in the contour at the base of a column. The usual history is a fall onto an outstretched hand. The fractures occur near the metaphysis, where the bone is most porous and the cortex thinnest. It results in buckling of the posterior cortex and angulation of the anterior cortex, which remains intact. The changes are due to compression of the long bone.One must carefully differentiate a true torus fracture from an incomplete greenstick fracture.A torus fracture and a greenstick fracture are sometimes used synonymously.A true torus fracture is stable,with disruption and compression of only one cortex.In a greenstick fracture both cortices are disrupted and are subject to late displacement.
On the AP view a subtle but slight bump is seen on the medial and lateral cortical margins. Sometimes the features are visible only on the lateral view. On lateral view there should normally a smooth line along the cortex of the long bone. Hence, the necessity of two views for evaluation of these fractures. The knowledge of such a deformity is essential so as not to miss the fracture. Follow-up radiographs show the presence of a transverse sclerosis, indicating osseous impaction.
Torus fractures are stable and require simple immobilisation and heal well without any residual deformity.
Differential Diagnosis List
Torus fracture
Final Diagnosis
Torus fracture
References
[1] Rogers LF. Radiology of Skeletal Trauma. Churchill Livingstone, New York, pp 805-6 (2002).
[2] Kirks DR. Practical Paediatric Imaging. Little, Brown and Co, Boston, p 344 (1991).
Case information
| URL: | https://www.eurorad.org/case/1802 |
| DOI: | 10.1594/EURORAD/CASE.1802 |
| ISSN: | 1563-4086 |
