Torus Fractures of the Distal Radius - Dushan Atkinson August 2006

An Increase in the Incidence of Torus Fractures of the Distal Radius During the Football World Cup 2006.

Adil Khan, Imran Hamid, James Mitchell, Henry Dushan Edward Atkinson

During the recent Football World Cup in June-July 2006 there was a noticeable increase in the number of children diagnosed with torus fractures of the distal radius in 2 Central London hospitals. 51 children were seen with this injury at the fracture clinics of St. Marys Hospital, London over the 4-week period, and 57 at Chelsea and Westminster Hospital , London , where the usual rates average 5-6 per week for the same annual period.

Children commonly sustain this injury by falling on an outstretched hand, however, mostof the injured children described having been struck by a football while goalkeeping, with their wrists having been forcibly pushed into volar or dorsiflexion.

Torus(or buckle) fractures, are extremely common injuries, and are the most common fracture of the forearm in children. ⁽¹⁾ ; the word torus is derived from the Latin 'Tori' meaning swelling or protuberance. They are incomplete fractures caused by a failure of one bony cortex in compression, with preservation of the opposite cortex, resulting in a buckling of the bone. This occurs due to the different physical characteristics of the bones in growing children compared to those of adults. Clinically there is often local swelling ⁽²⁾ and tenderness over the metaphysis ⁽³ . A radiograph of the wrist is diagnostic ⁽²⁾ ; the torus fracture appears as a bulge, or a buckle ⁽⁴⁾ of the distal radius. These injuries are in contrast with greenstick fractures, where one cortex has failed in compression and the other has failed in bending or rotation. The plastic deformation may not remodel can continue to angulate with growth ⁽⁴⁾ .

Torus fractures are nearly always stable injuries ⁽²⁾ and there is almost no risk of fracture displacement or late complications ⁽⁵⁾ . The standard treatment is the application of a Plaster of Paris backslab in the Accident and Emergency Department,providing symptomatic pain relief until the radiographs are assessed in the fracture clinic. Once the diagnosis is confirmed and more severe diagnoses excluded, the limb is put into a neutral forearm cast in order to minimise pain and prevent further injury. The cast is worn for 3-4 weeks after which it is removed in the fracture clinic, the limb re-examined ⁽²⁾ , and the limb mobilised.

As these fractures are stable with minimal risk of displacement, they may quite easily be managed in a splint at home by parents, rather than a formal forearm cast ⁽⁵⁾ ; and might eliminate the need for follow-up appointment in the fracture clinic ⁽⁶⁾ ,saving on hospital resources.

The Football World Cup appears to have encouraged children to play sport but not without consequence, as the increase in the number of these wrist fractures has indicated. However these fractures are stable with little associated morbidity, even without treatment ⁽³⁾ .

References

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5) Simple treatment for torus fractures of the distal radius. Davidson, J.S. Brown, D.J.Barnes, S.N. Bruce, C.E. J Bone and Joint Surgery. 2001 Nov; 83B(8):1173-5

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