Authors of section

Authors

Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

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33-M/2.1 Metaphyseal, torus/buckle

Definition

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.

Torus/buckle fracture of the distal femur

Further characteristics

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.

Further evaluation

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.