A 2 yo male presents to the ED with his mother because she is concerned about wrist pain.  Patient's mother reports that he fell on an outstretched hand 4 days ago at daycare and he seems to be using mostly his opposite arm now; he cries out with palpation of the affected wrist when parents are changing his clothes. On exam, patient has tenderness over his distal right forearm.  Pulses are intact and he has normal range of motion of his digits and brisk capillary refill.  An x-ray is shown.  What's the diagnosis.  Scroll down for answer.

Diagnosis:  Torus fracture of the right distal radial metaphysis

• AKA a buckle fracture
• most commonly in children
• compressive forces (axial load) results in buckling of the periosteum, usually involves the distal metaphysis; most common mechanism is a fall on an outstretched hand
• signs and symptoms: soft tissue swelling, point tenderness, usually no visible deformity
• x-ray will show asymmetry, bulging or deviation of cortex, non-displaced
• treatment: a short arm splint in position of function, analgesia, orthopedic follow up for short arm cast vs. removable splint

References:

Black KL, et al. “Musculoskeletal Disorders in Children.” in Tintinalli’s Emergency Medicine: A comprehensive study guide, 8e New Yourk, NY: McGraw-Hill; 2016.