33-M/2.1   Metaphyseal, torus/buckle

Torus/buckle injuries of the distal femoral metaphysis are classified as 33-M/2.1.

A torus fracture is, by definition, a failure of a single cortex in compression and is therefore minimally displaced and stable.

A buckle/torus fracture of the femoral metaphysis typically occurs in very young children.

Always consider deliberate injury in nonambulant children with a femoral fracture.

The fracture is intrinsically stable and heals rapidly.

If seen in older children it is often an indication of underlying bone disease.

Non-ambulant children with disuse osteopenia can have similar fractures especially if they have knee-joint stiffness.

It is essential to ensure that the opposite (tension) cortex is not involved.

This represents a greenstick fracture pattern, which is less stable and requires a different management strategy.