Title : Torus fractures of the distal radius in children: A review of the latest evidence
Abstract:
Background: Torus fractures, also known as buckle fractures, are amongst the most common paediatric orthopaedic injuries and typically affect the distal radius following a fall onto an outstretched hand. They occur due to the plasticity of the paediatric skeleton, where axial loading may cause cortical buckling without complete disruption. Although these injuries are stable, their management has historically varied, with many patients
previously treated using rigid immobilisation and routine follow-up.
Aim: This literature review aimed to summarise the epidemiology, anatomy, clinical assessment, diagnosis and evidence-based management of paediatric distal radius torus fractures, with a focus on promoting consistent and up-to-date practice among hospital clinicians.
Methods: A narrative review of the available literature was undertaken, including studies and guidance relating to paediatric distal radius fractures, torus fracture diagnosis, immobilisation strategies and follow-up requirements. Key sources included national guidance, randomised controlled trial evidence and relevant orthopaedic literature addressing clinical assessment, radiographic diagnosis and patient-centred management.
Results: Torus fractures commonly present in children following a fall onto an outstretched hand, with wrist pain and localised distal radial tenderness. Clinical assessment should include inspection for swelling, deformity or open injury, palpation for bony tenderness, assessment of wrist movement, distal neurovascular examination and consideration of associated injuries or non-accidental injury. Diagnosis is usually confirmed with plain wrist radiographs, including postero-anterior and lateral views, although findings may be subtle. Current evidence supports soft bandage treatment with immediate discharge for isolated distal radius torus fractures, once concurrent injury has been excluded. Rigid casting is not required, and routine specialist follow-up is usually unnecessary. This approach provides equivalent outcomes in pain and deformity compared with rigid immobilisation, while improving comfort, convenience and functional recovery for children and families.
Conclusion: Paediatric distal radius torus fractures are common, stable injuries that can be safely managed with soft bandaging, appropriate analgesia, safety-netting advice and discharge from first assessment. Standardising practice in line with contemporary evidence may reduce unnecessary immobilisation, follow-up appointments and healthcare burden, while maintaining safe and effective patient care.
