Pediatric emergency medicine trisk 3417 3417

suspicion should be maintained if there is a concerning mechanism or presence of
a joint effusion in the absence of radiographic abnormalities of the bone. These
fractures have the worst prognosis for growth disturbance as the compressive
force may result in premature closure of the physis. Unfortunately, the diagnosis
is often made in hindsight after a growth arrest becomes evident.

Torus Fractures
Torus (buckle) fractures are common fractures in young children. They most
often occur at the junction of metaphysis and diaphysis from a compressive load.
The cortex of the bone buckles in a small area, resulting in a stable fracture
pattern ( Fig. 111.3 ). As the child matures, the strength of the metaphyseal region
increases, and the incidence of this fracture pattern decreases.

Greenstick Fractures
The composition of pediatric bones makes them less likely to propagate the force
of injury into comminuted fragments. Thus, with greenstick injuries, the bone
bends before it breaks, with the thick and active periosteum remaining intact on
one cortex and acting like a hinge: torn on the convex side of the fracture while
remaining intact on the concave side. The intact cortex thus maintains apposition
at the site of fracture; however, to obtain an anatomic reduction, the fracture must
often first be completed. The emergency clinician must be attuned to this pattern
of injury as inadequate reduction of the deformation or bowing of the bone can
result in an abnormal growth pattern and loss of function ( Fig. 111.4 ).