965 children were in this study, which showed equivalent results for pain scores, function and complications between the treatments. This study fairly allocated children (through randomisation) to either splint and routine follow-up, or a bandage and no follow-up. The study was conducted throughout the UK in 21 emergency departments. However, in 2022 the largest and highest quality treatment study was published about this injury in the Lancet medical journal - called the FORCE Study (see infographic in images). There is no established 'standard' treatment for buckle fractures. The bone may have a slight angulation.The buckling of cortical bone, which may appear as a small bulge or protuberance in the radius or ulna.The diagnosis of a torus fracture is made from both anterior/posterior and lateral projections. Diagnosis īuckle fracturs can be identified by performing a radiograph. Such orthopaedic injuries are distinctive in children as their bones are softer and in a dynamic state of bone growth and development, with a higher collagen to bone ratio so incomplete fractures such as the buckle fracture are a more common occurrence. As aforementioned, the most common buckle fracture is of the distal radius in the forearm, which typically originates from a Fall Onto an Outstretched Hand ( FOOSH). Physical activities or sports such as bike riding or climbing increase the associated risk for buckle fractures in the potential event of a collision or fall. As with other fractures, the site of fracture may be tender to touch and cause a sharp pain if pressure is exerted on the injured area. This mechanism is analogous to the crumple zones in cars. ![]() ![]() As the bone buckles (or crushes), instead of breaking, they are a stable injury as there is no displacement of the bone. Torus fractures are low risk and may cause acute pain. Your child should avoid rough play and contact sports, as well as activities such as trampolining and skateboarding for a total of SIX weeks after the injury.Simplified diagram of a buckle fracture Signs and symptoms This should improve over the next week or two. Expect the wrist to be stiff for a few days after removal. After three to four weeks the splint should be able to be removed and left off. This is for your child to be reassessed to make sure pain is controlled and the splint is well-fitting. You may be asked to see your GP within 1 week. This is best done overnight so that the splint can be put back on for daytime activities. Hand wash in lukewarm water with mild detergent. Splints are usually more comfortable for the child and easier to care for. Research has shown that wrist buckle fractures will heal well in a splint which gives support and protection. If severe pain continues, or if there is a lot of swelling or numbness you should bring your child to your local doctor or the Emergency Department for review. Ask your child to move their shoulder, elbow, and fingers, so they don’t get stiff. If your child gets any numbness in the hand, you should loosen the splint. Give your child the dose that is recommended on the packaging for their age and weight. ![]() Pain medication like paracetamol or ibuprofen should be given regularly until your child is comfortable. However, the splint can be taken off for bathing, or if you need to wash the splint itself, as long as the removal is well tolerated by your child (Figure 2). A removable wrist splint should be worn for comfort for three to four weeks, day and night (except when it is removed for washing and drying) to reduce the chance of further injury. These fractures heal well with rest and time. This fracture is very common in children and presents as a bulge in the bone as it has been squashed If your child has fallen onto their wrist, they may have an injury known as a “buckle” fracture (Figure 1). The two bones in your child’s forearm are called the radius and ulna.
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