PubMed^® Literature Review

The distinction between buckle (torus) fractures and greenstick fractures is essential in pediatric orthopedics due to their unique presentations, implications for treatment, and healing processes [1][2][3]. Both fracture types are typically seen in children due to the biomechanical properties of their bones—specifically the thicker periosteum and greater bone plasticity compared to adults [1][2].

Buckle or torus fractures result from compressive forces causing the cortex on one side of a long bone to buckle without breaking completely [3]. Radiographically, these appear as raised or buckled protrusions at the site of injury without disruption of cortical continuity [3]. They are stable injuries often treated conservatively with immobilization using a splint or cast for approximately two weeks without routine follow-up being necessary given their low complication rates [7].

Greenstick fractures occur when an applied force causes bending such that there is a partial break involving only one side—the tension side—of the bone's cortex while leaving the opposite side intact but possibly bent [2]. This creates a situation where there is both cortical disruption and preservation within the same injury. Management depends on angulation severity; if significant displacement exists, reduction may be required followed by immobilization. Like buckle fractures, greenstick fractures also have good prognoses when managed appropriately [5].

Both fracture types can be understood through knowledge about pediatric skeletal anatomy. In children's bones, growth plates (physes) allow longitudinal growth via endochondral ossification—a process distinct from intramembranous ossification predominant in adult bones [2]. Children’s bones contain more cartilaginous components than those fully ossified structures found in adults; hence they exhibit different responses under stress leading to specific fracture patterns like greenstick and torus injuries rather than complete breaks typical in mature skeletons.

Radiological manifestations are pivotal for diagnosis since clinical presentation alone might not provide sufficient detail regarding fracture type. For instance, radiographs reveal characteristic features distinguishing between these two entities: outcroppings indicative of buckling in torus fractures versus unilateral cortical interruption seen in greenstick ones [6].

Treatment paradigms have evolved over time with an increasing emphasis on functional outcomes rather than solely radiographic appearance post-injury. Recent studies suggest direct discharge protocols after initial emergency department care could be non-inferior concerning patient satisfaction compared to traditional treatments involving rigid immobilization plus routine follow-ups for simple wrist torus or greenstick fractures among children—highlighting potential efficiency gains without compromising safety or efficacy [8].

In conclusion, understanding differences between buckle (torus) and greenstick fractures involves recognizing distinct biomechanical behaviors under stress due to pediatric-specific skeletal characteristics including open physes allowing growth along with thicker periosteums providing added protection against full-thickness breaks common among adults’ bones.