An Increase in Torus Fractures of the Wrist during the Football World Cup 2006 - Dushan Atkinson August 2006

An Increase in the Incidence of Torus Fractures of the Distal Radius During the Football World Cup 2006.

Authors:

Adil Khan, Imran Hamid, James Mitchell, Henry Dushan Edward Atkinson

During the recent Football World Cup in June-July 2006 there was a noticeable increase in the number of children diagnosed with torus fractures of the distal radius in 2 Central London hospitals. 51 children were seen with this injury at the fracture clinics of St. Marys Hospital, London over the 4-week period, and 57 at Chelsea and Westminster Hospital , London , where the usual rates average 5-6 per week for the same annual period.

Children commonly sustain this injury by falling on an outstretched hand, however, most of the injured children described having been struck by a football while goalkeeping, with their wrists having been forcibly pushed into volar or dorsiflexion.

Torus(or buckle) fractures, are extremely common injuries, and are the most common fracture of the forearm in children. (1) ; the word torus is derived from the Latin 'Tori' meaning swelling or protuberance. They are incomplete fractures caused by a failure of one bony cortex in compression, with preservation of the opposite cortex, resulting in a buckling of the bone. This occurs due to the different physical characteristics of the bones in growing children compared to those of adults. Clinically there is often local swelling (2) and tenderness over the metaphysis (3 . A radiograph of the wrist is diagnostic (2) ; the torus fracture appears as a bulge, or a buckle (4) of the distal radius. These injuries are in contrast with greenstick fractures, where one cortex has failed in compression and the other has failed in bending or rotation. The plastic deformation may not remodel can continue to angulate with growth (4) .

Torus fractures are nearly always stable injuries (2) and there is almost no risk of fracture displacement or late complications (5) . The standard treatment is the application of a Plaster of Paris backslab in the Accident and Emergency Department,providing symptomatic pain relief until the radiographs are assessed in the fracture clinic. Once the diagnosis is confirmed and more severe diagnoses excluded, the limb is put into a neutral forearm cast in order to minimise pain and prevent further injury. The cast is worn for 3-4 weeks after which it is removed in the fracture clinic, the limb re-examined (2) , and the limb mobilised.

As these fractures are stable with minimal risk of displacement, they may quite easily be managed in a splint at home by parents, rather than a formal forearm cast (5) ; and might eliminate the need for follow-up appointment in the fracture clinic (6) ,saving on hospital resources.

The Football World Cup appears to have encouraged children to play sport but not without consequence, as the increase in the number of these wrist fractures has indicated. However these fractures are stable with little associated morbidity, even without treatment (3) .


References

1) Fractures and Dislocations-Closed Management. Philadelphia .Saunders. 1995: p192

2) Current management of torus fractures of the distal radius. Solan, M.C. Rees, R. Daly,K. Injury. 2002; 33: 503-5

3) The uniqueness of the young athlete: musculoskeletal injuries. Wilkins, K. E. Am JSports Medicine. 1980 Sep-Oct; 8(5):311-8

4) Childrens fractures. Lippincott, J.B. Philadelphia 2 nd edition. 1983: p1-3

5) Simple treatment for torus fractures of the distal radius. Davidson, J.S. Brown, D.J.Barnes, S.N. Bruce, C.E. J Bone and Joint Surgery. 2001 Nov; 83B(8):1173-5

6) Hospital versus home management of children with buckle fractures of the distal radius.Symons, S. Rowsell, M. Bhowal, B. Dias, J.J. J Bone and Joint Surgery. 2001May; 83B(4):556-560





Please log in to view the content of this page.
If you are having problems logging in, please refer to the login help page.


© 2011 Orthoteers.co.uk Website by Regency Medical Marketing 
Biomet supporting orthoteersThe British Orthopedic Association supporting OrthoteersOrthoteers is a non-profit educational resource. Click here for more details
An audit of integrated care pathway...
An Increase in Torus Fractures of t...
Auditing Procedure Cancellation on ...
Auditing the effectiveness of Docto...
Cancellation of trauma cases in a L...
Current evidence in proximal humera...
Neurovascular status documentation ...
Osteoporotic Hip Fractures in the E...
Synovial Fluid pH as an Indicator o...
The Efficacy of Intramedullary Appl...
The Management of Hip fractures in ...
OWLS British Orthopaedic Association supports Orthoteers
Orthoteers Junior Orthoteers Orthopaedic Biomechanics Orthopaedic World Literature Society Educational Resources Image Gallery About Orthoteers Orthoteers Members search
Hide Menu