Buckle Fracture: Symptoms, Types, Causes and Treatment

Buckle fractures—also known as torus fractures—are among the most common bone injuries in children, but they can also occur in adults in specific situations. Understanding their symptoms, types, causes, and treatment is crucial for optimal care and peace of mind, especially for parents, caregivers, and patients themselves. This comprehensive guide will walk you through the essential information, clarify common misconceptions, and arm you with evidence-based knowledge to better handle buckle fractures.

Symptoms of Buckle Fracture

Buckle fractures can be subtle and sometimes mistaken for simple sprains or bruises, especially in young children. Recognizing the hallmark symptoms helps ensure early and effective treatment, minimizing discomfort and preventing unnecessary complications.

Symptom	Description	Typical Age Group	Source(s)
Pain	Localized, increases with movement	Children, Adults	3 6 11
Swelling	Around the injured area	Children	3 6 8 11
Tenderness	Sensitive to touch over the fracture	Children	3 6 8
Reduced Motion	Hesitancy to use limb, limp or refusal to bear weight	Children	3 6 8 11

Table 1: Key Symptoms

What to Look For

The signs of a buckle fracture often appear soon after the injury. While the pain may be mild or moderate, it is usually localized over the site of the fracture and worsens when the affected limb is moved or pressure is applied 3 6. Swelling is common, especially in children, and may be accompanied by visible tenderness, making it uncomfortable for the child to use the limb normally 3 6 8 11.

How Symptoms Present in Different Age Groups

• Children: Most buckle fractures occur in the distal radius (forearm near the wrist) or proximal tibia (upper shin). Children may refuse to use the limb, limp, or avoid putting weight on the leg. Swelling and tenderness are typical, but bruising is less common than with other fracture types 3 6 8 11.
• Adults: Buckle fractures are rarer but can occur, particularly in the ribs after events like CPR. These are often detected via imaging rather than obvious symptoms and may be asymptomatic or associated with mild discomfort 1.

Differentiating from Other Injuries

Because buckle fractures are stable and minimally displaced, the symptoms can mimic sprains or soft tissue injuries. However, persistent localized pain and tenderness after a fall or trauma—especially in a child—should prompt consideration of a buckle fracture 3 8 11.

Types of Buckle Fracture

Buckle fractures may seem straightforward, but they can vary based on location, pattern, and even the underlying cause. Understanding these distinctions helps guide treatment choices and anticipate recovery.

Type	Description	Common Sites	Source(s)
Distal Radius	Outward bulge at wrist end of forearm	Wrist (children)	3 7 8 9 10 11
Proximal Tibia	Compression near the top of the shinbone	Knee (children)	6
Buckle Rib	Incomplete, inner cortex fracture of the rib	Ribs (adults, CPR)	1

Table 2: Buckle Fracture Types

Distal Radius Buckle Fractures

• Most Common: The classic site for a buckle fracture is the distal radius, especially in children aged 4–15 years, often after a fall onto an outstretched hand 3 7 8 9 10 11.
• Pattern: The bone bends and compresses, causing a bulging or “buckle” of the cortex (outer bone layer), but does not break completely.

Proximal Tibia Buckle Fractures

• Also Known as "Trampoline Fractures": These occur near the knee, especially in toddlers and young children, commonly after jumping or falling on a bouncy surface 6.
• Pattern: Similar compression or buckling of the bone, sometimes extending obliquely toward the growth plate (physis).

Buckle Rib Fractures

• Rare in Adults: Typically seen as a result of chest compressions during CPR, these fractures involve only the inner cortex of the rib and are often detected via CT scan, not X-ray 1.
• Pattern: Incomplete fracture, with a “buckle” inward, not a complete break.

Other Notes on Classification

• Stability: All buckle fractures are considered stable, meaning they have little risk of displacement or complications 3 8 9 11.
• Imaging Features: Buckle fractures show up as subtle bulges or kinks in the cortex on X-rays, rather than clear breaks.

Causes of Buckle Fracture

Buckle fractures result from specific mechanisms that compress the bone, causing it to deform rather than break cleanly. Understanding how and why these injuries happen is crucial for prevention and early detection.

Cause	Mechanism	Age Group Most Affected	Source(s)
Falls	Fall onto an outstretched hand	Children	3 6 8 9 10 11
Trampoline/Bounce	Impact from bouncing surfaces	Young children	6 10
Direct Impact	Blow to bone (sports, play)	Children, rarely adults	6 8 10
CPR Compression	Chest compressions	Adults	1

Table 3: Common Causes

Falls

• Primary Cause in Children: Falls from standing, running, or while playing are the most frequent cause of buckle fractures, especially of the distal radius 3 8 9 10 11.
• Mechanism: The outstretched hand absorbs the force, compressing the bone and causing it to buckle.

Trampoline and Bouncing Surfaces

• Significant Contributor: Landing awkwardly on a trampoline or inflatable bouncer is a common cause of proximal tibia buckle fractures, sometimes called "trampoline fractures" 6 10.
• Not Just Trampolines: Any bouncy surface where multiple children are playing increases the risk, especially with older children present 6.

Direct Blows

• Less Common, but Possible: Direct impact to the limb from falls, sports, or collisions can cause buckle fractures, especially in younger children whose bones are more flexible 6 8 10.

CPR-Related Fractures

• Unique to Adults: Incomplete rib fractures known as buckle rib fractures can result from the forceful chest compressions performed during cardiopulmonary resuscitation (CPR) 1.
• Imaging Artifact: These are often detected on postmortem CT scans rather than being clinically significant injuries 1.

Why Are Children More Susceptible?

• Bone Properties: Children's bones are more porous and flexible, allowing them to deform (buckle) rather than break cleanly, which provides some protection but also makes this injury more likely 3 6.

Treatment of Buckle Fracture

Buckle fractures are stable and heal reliably, allowing for simple, minimally invasive treatments. Recent research has driven a shift toward more comfortable, family-friendly options, reducing the need for rigid casts and repeat clinic visits.

Treatment	Description	Follow-Up Needed	Source(s)
Soft Bandage	Simple bandage for comfort and protection	No	8 11
Removable Splint	Lightweight, removable support	No or minimal	7
Soft Cast	Flexible, waterproof cast	None or 1 visit	10
Rigid Cast	Traditional plaster cast	1 visit for removal	3 9 10

Table 4: Treatment Options

Modern Approaches: Less is More

• Soft Bandage: Large, multicenter trials have shown that treating distal radius buckle fractures with a soft bandage is just as effective as rigid immobilization, with similar pain scores and functional outcomes 8 11. Children can be safely discharged without further follow-up.
• Removable Splint: Splints provide support but can be taken off for hygiene. Studies show better physical function and satisfaction compared to rigid casting, with no increase in complications or pain 7.
• Soft Cast: Soft, flexible casts are comfortable, waterproof, and can often be removed at home by parents. Satisfaction is high, and there is no increase in adverse outcomes 10.
• Rigid Cast: Still used in some settings, but increasingly reserved for cases where additional support is needed or where family preference dictates 3 9 10.

Follow-Up and Aftercare

• Minimal Follow-Up Required: Evidence conclusively shows that buckle fractures do not displace after the initial injury, so routine repeat X-rays and clinic visits are unnecessary 3 8 9 11.
• Return to Activity: Children can resume normal activities as soon as comfort allows, typically within a few weeks.

Key Points in Treatment

• No Surgery Needed: Buckle fractures are inherently stable and heal without surgical intervention 3 8 9 10 11.
• Parental Guidance: Providing parents with clear instructions and reassurance about home care and when to seek help is essential 9 10.
• Pain Management: Simple pain relief (acetaminophen or ibuprofen) is usually sufficient 7 8 11.

Conclusion

Buckle fractures are among the most common and least complicated fractures, especially in children. Their distinctive symptoms, reliable stability, and favorable outcomes make them unique in the world of bone injuries. By staying informed about their symptoms, types, causes, and evidence-based treatment, patients and families can feel confident in the recovery process.

Key Takeaways:

• Buckle fractures present with localized pain, swelling, and tenderness, mostly in children after falls or bouncy play.
• The most common types are distal radius and proximal tibia fractures in children; buckle rib fractures can occur in adults after CPR.
• Falls, trampolines, and direct impacts are the main causes in children, while CPR is a unique cause in adults.
• Simple treatments like bandages, splints, or soft casts are highly effective, and routine follow-up is often unnecessary.
• Modern evidence supports minimal intervention and early return to normal activities, supporting both safety and convenience for families.

Understanding and managing buckle fractures has never been simpler, thanks to robust research and evolving best practices. If you or your child experience a suspected buckle fracture, rest assured: with the right approach, full recovery is the norm.