![]() Most authors agree that where angulation is less than 20 degrees, manipulation for reduction is not required and only symptomatic support is required: this is usually in the form of a removable splint. Some advocate the reduction of a bowing fracture where angulation exceeds 20 degrees. In isolation, treatment of bowing fractures is debated 2. Treatment and prognosisīowing fractures usually accompany another fracture and in those cases, treatment is determined according to the type and severity of the accompanying injury. In some cases, there may be dislocation of the paired bone, e.g. radius, and this is usually diaphyseal (either greenstick or complete). There is usually an accompanying fracture of a paired bone, e.g. There is no fracture line or visible cortical injury. The bowing tends to be fluid and blend into the normal bone at either end. If the view is in the plane of the bow, the bone may appear completely normal 1. On a plain film, bowing of the bone can be visualized provided that the view is in a different plane to the direction of bowing. Microscopic examination of the bone reveals that there are microfractures along the concave border of the bowed bone, but these are not visible radiographically. If the force is greater than the mechanical strength of the bone, the bone undergoes plastic deformation and when the force is released, the bone remains in its bowed position. This ability to bend occurs because the cortex is thinner in absolute and relative terms compared to adult bones and because of the way the cortex and periosteum bind to each other in the developing skeleton. ![]() 1 It is a common occurrence following a fall, as the wrist absorbs most of the impact and compresses the bony cortex on one side and remains intact on the other, creating a bulging effect. Pediatric bones have a degree of elasticity and therefore, if the force is low and subsequently released, the bone returns to its normal position and no lasting evidence of that bowing is seen radiographically. A Torus fracture, also known as a buckle fracture is the most common fracture in children. When an angulated longitudinal force is applied to a bone, the bone bends. This is often after falling from furniture or climbing equipment, especially monkey bars. Clinical presentationĬhildren present with pain and swelling following a fall, usually on an outstretched hand. However, bowing fractures of all long bones have been described. The radius and ulna are the most commonly affected bones, followed by the fibula. These injuries usually occur in children although adolescents may be affected. However, there have been several case reports of bowing in adult bones. For the first few days after applying a cast the physician may have the child wear a sling to give the arm some support.Bowing fractures are almost exclusively found in children. They should also keep the arm elevated when sitting down. If the child is in pain, the physician will have them to take over-the-counter pain medication. To make sure that the bone has healed properly there will be a second set of x-rays done before they remove the immobilization device. If they remove the splint, it will delay their recovery. Most physicians prefer to cast the fracture because the child cannot take it off as easy as they can a splint. Some physicians will put a splint on the fracture instead of a cast if the fracture is a minor wrist fracture. This type of fracture is the one that is quickest to heal so that is why it usually only takes three to four weeks of wearing a cast to heal a torus fracture. The main reason for casting and immobilizing the fracture is to help with the discomfort and pain. This type of fracture is normally treated by casting the fracture for three to four weeks in a short arm cast to help prevent further injury. If it does not show a torus fracture on the first set of x-rays but there still seems to be a problem they will normally do a second set of x-rays two weeks after the first set. When doing the x-rays they will take x-rays of the elbow and wrist to rule out any dislocations. ![]() If the physician feels there may be a torus fracture, they will order x-rays to be taken to see if there are any signs of buckling. This can happen if a child falls off their bicycle, roller skating, using a skateboard, or falling off furniture, bed, or playground equipment. Many of these fractures occur when a child falls and stretches out their hand during the fall to catch themselves but the impact is too great. In older children they may be very protective about the part that is fractured.In babies and toddlers they may cry and be inconsolable.Inflammation and swelling that can cause reduced movement and stiffness of the wrist joint.
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