Buckle fractures are compression fractures and are very common in children. They happen when one side of the bone buckles, or bends, but doesn't break all the way through.
It is a stable fracture, meaning that the broken pieces of bone have not separated from each other.
They are sometimes called torus fractures and are an example of an incomplete fracture. Another example of an incomplete fracture is a greenstick fracture, which is when the bone bends and cracks, but does not break all the way through. Greenstick fractures are also more common in children than adults.
It can take up to 6 weeks for a child to heal from a buckle fracture, and longer for an adult.
These injuries are very common in children and tend to occur in the arm or leg.
Children are more at risk of buckle fractures than adults as their "long bones," or arms and legs, contain growth plates. These are softer areas of cartilage that harden into solid bone as the child grows up.
Because children's bones are quite flexible, they tend to bend rather than break when they are put under pressure.
Taking part in sports, rough play, and other typical childhood activities, such as running around and climbing trees, are all risk factors for buckle fracture.
Adults can also suffer a buckle fracture, though it is not as common. Those at risk include people who have a condition called osteoporosis, which means they have weak bones, and those who take part in contact or extreme sports.
If a person has broken a bone, they will feel a lot of pain, and there will be swelling, bruising, or tenderness at the site of the break. If the break is in an arm or leg, the limb may look misshapen, but with a buckle fracture, there is often no irregularity.
If someone suspects a break, they should keep the limb still, possibly using a splint, and raise it higher than the heart to reduce swelling. Pain relief may also be needed. Avoid heating the area.
As with all kinds of breaks, it is essential to get treatment as quickly as possible, especially in the case of children. Their bones heal quickly, and it is important to make sure the bone is supported to do so properly.
At the hospital, a doctor will offer a physical examination and possibly an X-ray to diagnose a buckle fracture.
In most cases, a buckle fracture is treated with a splint and cast. A splint is usually put on first, which keeps the limb in place for the first few days until the swelling goes down. However, if there is no or minimal swelling, a cast may be applied immediately.
After any severe swelling has subsided, a plaster or fiberglass cast is then put on. A soft inside layer protects the skin and soft tissue, and a hard layer holds the bones in place so that it can heal.
For children, the usual healing time for a bone is 3 to 6 weeks but may take longer based on the child's age, and they will need to wear their cast for the whole time. For adults, this can take longer.
In the unlikely event that the bone has been angled, or bent out of shape, it may need to be reset to get better alignment. The doctor will do this, and depending on how severe the deformity is, the procedure may be carried out under sedation or general anesthesia.
When this occurs, the patient will need to have more X-rays in the first 7 to 10 days after the break, to make sure the bones stay lined up.
People who have a simple buckle fracture will not usually be kept in the hospital. For the first few days, there may be swelling and discomfort or pain. To reduce this, raise the injured limb, and rest it on a pillow.
In the case of a fractured arm, the person may wear a sling when standing up or walking.
If they have a broken leg, they will need complete rest, with the leg elevated, for the first few days after the break. After that, they will need crutches to move around and will need to take care not to disturb the bone while it is healing.
While the bone is healing, people will need to take some time off school or work and take a rest from usual activities. The exact length of this rest will depend on the severity and location of the fracture. People should speak to their healthcare team if they are unsure.
Living with a cast
Anyone wearing a cast will need to take care not to get it wet as this will weaken the plaster and its ability to keep the bones straight.
It is important to keep a fiberglass cast dry and clean as well to prevent softening and breaking down of the skin. When showering, a plastic bag can be wrapped around the cast and secured with an elastic band to protect it.
The skin under the cast may feel itchy for the first few days, but doctors advise not to put anything inside the plaster to scratch, as it may cause a sore.
Turning a hair dryer onto a cold setting and blowing underneath the cast may help but needs to be done very carefully without any heat so as to prevent damage to the skin. People should speak with their orthopedic surgeon before doing this.
It can be uncomfortable to wear a cast, particularly if it is for a relatively long time.
The British National Health Service (NHS) offer some top tips for living with a cast:
- exercise any joints that are not covered by the cast to improve circulation
- try not to get powders and creams inside the cast
- no heavy lifting or, in the case of adult patients, driving while wearing the cast
- using crutches or a sling if the medical team advises it
The NHS also recommend seeking medical attention if:
- the plaster feels too tight after keeping the limb elevated for 24 hours
- the fingers or toes on the affected limb feel swollen, tingly, or painful
- the fingers or toes on the affected limb turn blue or white
- the cast feels loose
- the cast is broken or cracked
- the skin underneath or around the plaster cast is sore
- there is an unpleasant smell or discharge coming from underneath the cast
Fractures of the wrist and forearm account for almost half of all bone breaks in children. Most of these are buckle fractures.
It is an extremely common event, and the vast majority of buckle fractures are treated quickly and easily with a cast or splint. Children experiencing a buckle fracture do not tend to develop any related problems later on.
While adult bones take longer to heal from a fracture, most people do make a full recovery.