2/20/2023 0 Comments Buckle fracture![]() ![]() describe this derivative as angulation of the cortex in response to the combination of the traditional axial loading with additional transverse force from either hyperflexion, hyperextension, valgus, or varus directions. Angled DRBFs have also been observed in other long bones such as the distal femur and distal tibia. when the authors found that plastic deformation of the distal humeral metaphysis led to significant angulation accompanied by a posterior fat pad sign and without cortical disruption. The phenomenon was first defined by Rogers et al. The authors argue that a buckle fracture can exist in a secondary and more subtle form due to an unusual off-centered compression mechanism. as a commonly undiagnosed derivative of pediatric DRBFs. The angled DRBF (Figure 2) was first depicted by Hernandez et al. ![]() This high rate of misdiagnosis implies an increasing need for a universal set of diagnostic criteria. As concluded by Terreblanche et al., there is a reasonable amount of misdiagnosis: up to 46% of diagnosed DRBFs were later classified as non-buckle distal radius fractures with intraphyseal or cortical disruption. Due to these discrepancies, the literature diagnoses DRBFs with varying degrees of accuracy. This ambiguity further complicates the identification of buckle fractures when there is extension into the metaphysis or when the fracture is purely unicortical. Others believe that the load pattern and subsequent bone deformation delineate a buckle fracture. Some authors believe the injury must convey inherent stability to be classified as a buckle fracture. There is an active debate on what constitutes a true buckle fracture. īuckle fractures and their angled counterparts Additionally, children have a thick periosteal sleeve above the cortex that typically stays intact and prevents unrestrained fracture extension and complete bone failure. Buckle fractures are usually specific to children because their bone has a lower ash content (less hydroxyapatite) and is more likely to absorb force and experience plastic deformation. When axial loads surpass the plastic deformation threshold, trabeculae fail and cause the cortex to bulge outwards at the apex of the compressive forces. This transition point is susceptible to failure due to the different biomechanical characteristics of the two types of bone: developing woven bone of the metaphysis and tough lamellar bone of the diaphysis. DRBFs are most commonly caused by low-energy falls on an outstretched hand, resulting in axial loading of the meta-diaphyseal junction of skeletally immature long bones. Further research is essential to determine the stability of the angled DRBF subtype and whether they should continue to be defined and managed as buckle fractures.ĭistal radius buckle (torus) fractures (DRBFs) (Figure 1) are the most frequent type of pediatric fracture and account for the highest number of fracture visits to emergency departments in the United States. Radiographic evidence supporting or denying this claim is limited. Angled DRBFs have been theorized to have intraphyseal extension, making them unstable Salter-Harris fractures. Despite the discrepancies in categorizing DRBFs, complication rates remain low, and diagnostic confusion insignificantly affects clinical outcomes. Yet, new protocols implementing removable elastic bandages have had comparable results to casting, including reduced healthcare expenditure, less stiffness, and improved convenience and patient tolerability. Rigid immobilization with short-arm casting continues to be the mainstay of treatment in clinical practice. Without universal diagnostic criteria, misdiagnosis is common, and the utilization of flexible treatment modalities is infrequent. Some authors refute the existence of angled DRBFs, instead proposing new criteria for DRBF classification: measuring more than 1 cm away from the physis with two to three inflection points. In this review, we discuss angled DRBFs, a hypothesized subset of buckle fractures that results from an off-center compressive force. DRBFs lack cortical and physeal disruption, which makes them relatively stable. They result from compressive forces applied to a child’s highly plastic radius. Distal radius buckle fractures (DRBFs) are the most common pediatric fractures and resemble the rounded portion of a Greek pillar or torus. ![]()
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