Pain of the right distal forearm after a fall.
The patient complained of swelling and distal forearm pain after a fall on his right outstreched wrist and hand. Routine X-ray films revealed the typical appearance of torus fracture of radius and ulna (figure 1).
Longitudinal compression of the bone can cause incomplete fractures in children because of the unique relative plasticity of their bones. These include bowing, torus, greenstick and stress factures. Torus is derived from latin (tori), meaning a swelling or protuberance. Also known as a buckle fracture, this is an impaction fracture in which the cortex around all or part of the circumference of the bone is buckled. Although it can occur in any long bone, the distal radius is the most common site (1). This type of fracture usually occurs near the metaphysis, where the porosity of the bone is greatest, and is most common in children (2). The etiology is usually a fall on an outstretched arm. The child usually presents with a painful and swollen wrist. Radiographic finding is a definite cortical bulge usually occurring at the metaphysis, two to four centimeters from the distal growth plate (figure 1). This sign is often better seen on the lateral film (figure 2). It is wise to include both the wrist and elbow to rule out dislocation of the proximal and distal radio-ulnar joints. Occasionally, the radiograph is normal and the diagnosis must be made from the clinical findings.
A combination of a greenstick and torus fractures is termed lead pipe fracture (figure 3) (4).
Torus fracture
Based on the provided anteroposterior and lateral X-ray images, there is an outward bulge or protrusion of the cortical bone at the transition zone between the distal radius metaphysis and diaphysis (commonly 2–4 cm proximal to the physis). This presents as a “buckle” or “torus” remodel, consistent with a typical radiographic appearance of a distal radius “buckle” or “torus” fracture. The distal ulna shows no significant abnormalities. No obvious fracture lines traverse the entire cortical bone. Mild soft tissue swelling is noted around the area, with no apparent joint dislocation or bony displacement.
Taking into account the clinical details (history of trauma, age, localized pain) and imaging characteristics, a torus fracture is the most consistent diagnosis.
Based on the patient’s trauma history (fall resulting in distal radial pain), age (7 years old, bones with higher plasticity), and X-ray findings (localized cortical “bulge”), the most likely final diagnosis is:
Distal Radius Torus (Buckle) Fracture of the Right Forearm
No other associated fractures or joint dislocations are evident at present. If there is a need to rule out subtle fractures or physeal injuries, MRI or further follow-up can be considered.
The goal of rehabilitation is to facilitate fracture healing, maintain joint mobility, and reduce the risk of long-term functional limitations. A progressive, individualized approach is recommended, as follows:
Because the patient is still in a growth phase, close monitoring of the growth plate area is essential. If persistent pain or unsatisfactory functional recovery occurs, prompt re-evaluation is advised.
Disclaimer: This report provides a reference medical analysis based on the patient’s basic information and imaging data. It does not replace the clinical consultation or professional opinion of a physician. Specific treatments should be determined by qualified medical institutions and professionals in light of the patient’s actual condition.
Torus fracture
