Buckle Fracture

Pediatrics bones and fractures are different than those in adults.  A common wrist injury in kids is known as a “buckle fracture”.  While adult bones tends to crack like a piece of chalk, the forearm bones (radius and ulna) of kids tend to “buckle”, or collapse and deform like a piece of Play-Doh.

Buckle fracture of the wrist (radius bone) in a child

The vast majority of buckle fractures can be treated in a cast or removable brace. A buckle fracture of the wrist typically takes 4-6 weeks to heal. The younger the child, the quicker the bone heals.  Typically, a repeat x-ray will be taken approximately 4-6 weeks after the injury. Once the "buckle" has filled in with bone, and the child no longer has pain when pressure is applied to the area, the splint or cast can be removed. For the first week or two after cast removal, it is often advised to avoid higher risk activities such as playgrounds, scooters, bikes, and sports without a splint in

While most buckle fractures of the wrist heal uneventfully, some wrist fractures in kids may need to be set. The degree of “displacement” (the shift or angulation of the bone pieces), along with the child’s age determines the ideal treatment. Older kids (>10 years old) have less ability to "remodel" the bone. The older the child, the less time available for the bone to straighten itself out with normal growth. Minimally displaced fractures usually heal uneventfully in a cast or splint. Occasionally, the fracture fragments are shifted or notably angled. In these cases, setting the bone may be required to minimize growth disturbances and optimize function of the hand going forward.

Throughout treatment, it is important to continue to move the fingers to prevent stiffness and minimize swelling. After the fracture heals, therapy may occasionally be needed to recover motion of the wrist, strength, and function. In general, kids tend to recover their motion and strength much more quickly than adults, and most kids are back to themselves after a couple of months.

Example 1. Left: A buckle fracture of the wrist is an indentation in the bone. Center: After one month, new bone can already be seen that the body has added to the indentation site to stabilize and protect it. Right: After two months, the bone looks completely normal on x-rays, a process called remodeling.

Example 2. Left: more severe fracture that extends completely across the radius bone. Right: Healing after 6 weeks, showing a new layer of bone formation around the fracture. With more time, the fracture will disappear, as the new bone blends into the old bone.