PEDIATRICS
GREENSTICK, TORUS,ANDBOWINGFRACTURES
These fracture patterns occur almost exclusively in children due to the plia-
bility of bone (see Figure 5.22). Torus fractures are also known as compres-
sion or buckle fractures. Bowing fractures are also known as plastic deforma-
tion fractures.
DIAGNOSIS
■ Torus fracture: Mechanism is usually axial compression, such as occurs
with a fall on an outstretched arm. Most common site is the distal radius.
■ Greenstick fracture:Mechanism is usually axial compression with twist-
ing, such as occurs with falling backward on a supinated or pronated fore-
arm. XRs show an intact bony cortex on one side with a fracture through
the cortex on the opposite side.
■ Bowing fracture:Mechanism is usually from longitudinal compression.
Clinically, the patient will have a deformity suggesting a fracture. XRs
show a bowing deformity without an obvious break in the bony cortex.
Comparison views with the opposite extremity are extremely helpful and
often necessary.
TREATMENT
■ Torus fracturesare treated with simple casting for 2–4 weeks.
■ Greenstick fracturesmay require reduction of the rotational or angular
deformity in addition to casting.
■ Bowing fracturesshould be referred to an orthopedic surgeon for evalua-
tion because remodeling is minimal and these fractures are commonly
associated with long-term cosmetic and functional deficits.
ABCFIGURE 5.22. Pediatric fractures. A: Greenstick fracture. B: Torus fracture. C: Plastic
deformation (bowing fracture).
(Reproduced, with permission, from Skinner HB. Current Orthopedics, 4th ed. New York:
McGraw-Hill, 2006:636.)