U01.11.027 Common pediatric fractures

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Learning Objectives

  • Distinguish between Greenstick and Torus (Buckle) fractures by mechanism of injury.
  • Identify the “tension” vs. “compression” side failure in incomplete pediatric fractures.
  • Explain why these fracture types are unique to immature bone.

1. Greenstick Fracture

An incomplete fracture that occurs when a bone bends and cracks, instead of breaking completely into separate pieces. It is named after the way a “green” (young) twig breaks—one side stays intact while the other splinters.

  • Mechanism: Bending stress applied to the bone.
  • Pathophysiology: The bone fails on the tension (convex) side. The compression (concave) side remains intact.
  • Clinical Note: These often require reduction (straightening) because the intact side acts like a spring, maintaining the deformity.

2. Torus (Buckle) Fracture

A common pediatric fracture where the bone “buckles” or bulges rather than breaking. This occurs because children’s bones are softer and more flexible than adult bones.

  • Mechanism: Axial force (e.g., falling on an outstretched hand, pushing the bone ends toward each other).
  • Pathophysiology: The cortex buckles on the compression (concave) side. The tension (convex) side remains solid and intact.
  • Clinical Note: These are stable fractures and typically only require a splint or cast for comfort rather than a full reduction.

3. Comparison Summary

Feature Greenstick Fracture Torus (Buckle) Fracture
Primary Force Bending Axial (Compression)
Side that Fails Tension (Outer curve) Compression (Inner curve)
Appearance Partial break/splinter Cortical bulge/bump

[Image comparing greenstick vs torus vs complete fractures in children]

Clinical Notes & Step 1 Pearls:

  • Why only kids? Children have a thick, active periosteum and bones with lower mineral content, allowing the bone to deform significantly without a complete “snap.”
  • Radiology: Torus fractures can be very subtle on X-ray; look for a slight disruption or “step-off” in the smooth line of the bony cortex.

Activity: Pediatric Fracture Identification

Quick Mnemonics:

Torus: Think “Torus” sounds like “Taurus” (the bull)—the bone Buckles under the weight.

Greenstick: Just like a young tree branch; it splinters but doesn’t snap.

Activity