torus fracture

Greenstick fracture


Almost exclusively occurs during infancy and childhood. The bending of a bone with incomplete fracture, involving the convex side only. Green stick fractures are characterized by a break in the bone which partially extends across and then along the length of the bone forming the characteristic fracture pattern for which it is named. There are three basic forms of greenstick fractures. In the first a transverse fracture occurs in the cortex, extends into the midportion of the bone and becomes oriented along the longitudinal axis of the bone without disrupting the opposite cortex. The second form is a torus or buckling fracture, caused by impaction. The third is a bow fracture in which the bone becomes curved along its longitudinal axis. A bone fracture in a young individual in which the bone is partly broken and partly bent.

Pathogenesis and risk factors

The green stick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a green stick fracture. The fracture usually occurs in children and teens because their bones are flexible unlike adults whose brittle bones usually break. Also called a Buckle Fracture or Torus Fracture.

Clinical features


Standard treatment is closed reduction and cast application which work in concert to straighten the characteristic bone angulation at the fracture site. Fracture reduction is straightforward; pressure is applied to the apex of the deformity and the bone straightens. Although rarely necessary, postoperative traction may be utilized to straighten a particularly resistant fracture. Typical post-op treatment is simply the application of a cast to stabilize the affected limb. Once applied, a cast is usually in place for three or more weeks depending on the severity of the fracture and rate at which the bone heals. During this period the patient should be encouraged to elevate the casted extremity above the level of the heart to reduce edema (swelling) and to exercise/move the joints above and below the cast in an effort to maintain and promote flexibility and muscle strength. Once the cast is removed a period of activity restriction in conjunction with informal physical therapy is typically necessary to regain pre-injury strength and mobility. It is not usually necessary to have formal physiotherapy.

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