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What Is a Buckle Fracture in Children?

Medically Reviewed by Poonam Sachdev on July 22, 2022

Buckle fractures are a type of bone injury that happen in children. They're incomplete fractures — the bone is not broken all the way through. These fractures result from sudden force or pressure applied to a bone, usually caused by a fall. Buckle fracture treatment differs from regular fractures. A cast or surgery is almost never needed. Buckle fractures are also called impacted fractures or torus fractures.

What Is a Buckle Fracture?

Buckle fractures usually happen when a child falls onto their outstretched hand. The sudden pressure on the bone "buckles" the bone. Most buckle fractures happen to the forearm bones, but other bones can have such fractures. The bones frequently involved are:

  • Radius (one of the two bones in the forearm)
  • Ulna (the other forearm bone)
  • Humerus (the arm bone)
  • Tibia (the shin bone)
  • Fibula (a slim bone in the leg)
  • Femur (the thigh bone)

One in four children with a broken bone has a buckle fracture. Adults rarely have them because the bones have hardened and break rather than bend. However, buckle fractures do happen in adults, in flat bones like the ribs. 

Buckle fractures, or impacted fractures, are usually not seen in smaller bones like those of the hands, fingers, or thumbs. Examples of impacted fractures are seen in the fractures at the wrist when a child falls and stretches out their hand. The radius is most likely to be fractured in this situation. 

Buckle Fracture Symptoms

The common symptoms of a buckle fracture are pain, tenderness, and swelling. You may see bruising over the area of the fracture. Your child will avoid the use of one hand or refuse to walk. If these symptoms appear after a fall or other injury, you should consult your doctor.

Your doctor will ask for an x-ray (or two, from different angles) of the affected limb. These will show the typical appearance of a buckle fracture.

Your doctor will also look for other injuries that you or your child may not have realized. A buckle fracture near the wrist is common when a child falls onto their outstretched hand. But fractures of the forearm bones near the elbow and a fracture of the arm bone (supracondylar fracture) may also happen.

Buckle Fracture vs. Greenstick Fracture

Though both are seen in children, these two types of fractures are different. Greenstick fractures happen when a child's flexible bone is bent. It cracks but doesn't break into two.

Buckle fractures happen when sudden pressure is applied to a bone on its long axis. The bone bulges in one place. Such fractures look like a bump on a bone. Both these types of fractures are seen most often in children under 12 years old.

A greenstick fracture is usually immobilized in a cast. This helps the cracked bone to heal and saves it from breaking if your child falls on it again.

Buckle Fracture Treatment

Buckle fractures do not need to be immobilized in a plaster cast. The usual treatment is a splint to provide support to the fractured limb. Your child can remove it during hand washing and bathing, but should otherwise wear it all the time. This includes while sleeping.

Your child will need this splint for two to three weeks. During this time, you should encourage your child to use their hand. Writing, coloring, and using a knife and fork are activities that help prevent the wrist from becoming stiff.

Your doctor will prescribe medicines to reduce swelling and relieve pain. Keeping the limb elevated also helps reduce the swelling. Your child shouldn't participate in contact sports for six weeks.

After the three weeks are over, your child should not wear the splint. If there is soreness, they can wear it for comfort, but only for short periods. It is important to start using the limb normally.

Your child should avoid rough play and contact sports for six weeks, as there is a risk of re-fracture. Safe activities like swimming should be started as soon as possible. If they complain of pain at the fracture site after six weeks, or of tingling and abnormal sensations, you should see your doctor.

You can help your child's fracture heal by giving them a healthy diet with plenty of calcium and vitamin D.

Do Buckle Fractures Need Treatment?

The bone has suffered a significant injury, and you shouldn't neglect it. You should consult a doctor, preferably an orthopedic surgeon. They have specialized training in the diagnosis and treatment of bone and joint injuries. 

Even though the bone is not completely broken, your child has considerable pain and swelling. Your doctor will prescribe medicines to provide relief. 

The treatment of buckle fractures is simple, but your doctor must make sure the injury is not more serious. They will get an x-ray (or two) to make sure it is not a complete fracture. A complete fracture may be displaced — the two parts don't line up. It is crucial to put the displaced bone back in place before applying the splint or cast (a procedure called reduction). 

Without proper treatment, even buckle fractures can cause long-term problems:

Nonunion. If a properly fitting and supporting splint is not applied, the bones may not join again. 

Malunion. Your doctor will ensure that the fractured bone is correctly aligned while it heals. Without proper support, the bone might heal at an angle, creating difficulty in using the limb.

Prolonged symptoms. Proper treatment relieves the pain and reduces the swelling. Untreated buckle fractures can cause a lot of suffering as the pain persists.

Danger Signs

The symptoms of buckle fracture (pain, swelling, and bruising) also happen with complete fractures of the bone. If your child has had a fall or other injury, watch out for these signs:

  • Intense pain
  • Swelling
  • Changed shape of the limb
  • Bone visible through the skin
  • Inability to move the part

These signs signify a more serious injury. You should take your child to the emergency room right away. You shouldn't wait for your doctor's clinic to open, and urgent care centers are often not equipped to handle major injuries. 

Buckle fractures are one of the most common injuries in children. If treated appropriately, they usually heal quickly and completely. A broken bone sounds scary, but this type of fracture usually allows function and does not require school absence. The outlook with buckle fractures is good — almost all children make a full recovery and have no remaining pain or disability.

Show Sources

SOURCES: 
Asokan A., Kheir N. StatPearls, "Pediatric Torus Buckle Fracture."
Cleveland Clinic: "Buckle Fracture (Impacted Fracture)."
Mayo Clinic: "Greenstick fractures."
National Health Service: "Buckle Fracture," "Torus "Buckle" Fracture."
Nemours Children's Health: "Broken Bones."

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