Buckle Fractures

The commonest type of Childhood fractures are the Greenstick and buckle fractures. But how are they managed.

An update on Buckle fractures

The commonest fractures on children are buckland and greenstick but what does this atually mean. There does seem to be some confusion with radiological definitions of a buckle deformity and orthopaedic definitions of buckle fractures.

From my point of view I think the most useful definition is that a buckle fracture is always undisplaced and never angulated. I don't think it is useful to describe an angulated or minimally displaced buckle fracture.

http://rnzcuc.org.nz/wp-content/uploads/2016/12/buckle-fx-ap-300x200.jpg

Any angulation means the fracture deeper than just the surface and should be described as a minimally displaced or minimally angulated or angulated greenstick fracture. I believe it is not orthopaedically correct to use the term angulated buckle fracture. The reason for this is that angulation can increase. Thus it is better to only use buckle fracture terminology for the undisplaced fractures as this is more anatomically and pathologically correct and makes management more consistent.

A true buckle fracture only involes one cortex and is stable and will not angulate. There are many studies supporting the use of splinting or removable splints for 3 weeks for buckle fractures.

The debate occurs when we consider the greenstick fracture. These may be undisplaced or angulated. They have the potential to angulate further.

When it comes to forearm fractures a lot has been written. They may even need manipulation if angulation is unacceptable. What is acceptable angulation is somewhat under debate and different orthopaedic surgeons have differing opinions. In general fracture that are greensctick and greater than 2.5cm from the distal radius require above elbow casting and those below the age of six usually require above elbow casting purely becasue the cast will simply slip off.

http://rnzcuc.org.nz/wp-content/uploads/2017/02/589fa30303511b82fd4c188fcd47066b-620x400.jpg

For your information have a look at this.

Buckle and Greenstick fractures

Reference

Abraham, A., Handoll, HHG & Khan, T (2008) Interventions for treating wrist fractures in children (review). The Cochrane Library. Cochrane Review in pdf