The porosity and compliance of the metaphyses of children's long bones, coupled with the relative thickness of the periosteum in this area, confer unique fracture characteristics. Compressive forces often result in a bulging or buckling of the periosteum rather than a more complete fracture line. Cortical, or torus, fractures are so named to describe a prominence or bulging of the bony cortex, usually involving the metaphysis.
Diagnosis is based on point tenderness over the site of the torus fracture. While a simple torus fracture does not produce a visible deformity of the extremity, soft tissue swelling routinely overlies the bone injury. In children who are not morbidly obese, the torus fracture is frequently palpable as a ridge over the metaphyseal area of the long bone.
Radiographically, the manifestation of a torus fracture may be somewhat subtle. Interpretation of radiographs is aided by following the contour of the metaphyseal flare, observing any asymmetry, bulging, or deviation of the cortical margin. With magnification, deviations in the trabecular pattern of the cortical markings can be seen to be associated with the bulging prominence of the cortical margin.
Since torus fractures are not typically associated with severe angulation, displacement, or rotational abnormalities, most can be competently managed by the emergency physician. Reduction techniques are rarely, if ever, necessary. The extremity is splinted in a position of function for 3 to 4 weeks. Aftercare can be arranged through the child's primary care physician or an orthopedic consultant, usually in 2 weeks. Analgesia requirements in the immediate days after the injury are usually minimal following the application of the splint.
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