American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North America

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February 12, 2018

Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer tender or painful.

Buckle (torus) fractures are very common injuries in young children, especially in the distal radius. The fracture is one of compression, where the metaphyseal bone impacts on itself, and actually becomes denser. These fractures are inherently stable and do not necessarily require a formal cast, unless severe pain or fracture instability necessitates a cast for 4 weeks. Instead immobilization with a simple wrist brace or removable splint is often preferable. The mild cortical angular deformity reliably remodels over time and requires no intervention or monitoring. If the fracture is non-tender to palpation at 4 weeks post-injury, no follow-up radiograph is required, and full activities may be resumed.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Medicine Committee and the Advocacy Committee worked together during 2014 and 2015 to develop five items in the practice of Pediatric Orthopaedics of tests or procedures that should not be done routinely. Approximately 20 members of these two committees participated in the process. Each surgeon, in a blinded fashion, submitted 5 items each from their practices and experience of tests or procedures that they found were commonly over-utilized. The items were tallied in order of number of times that item was listed by each surgeon. A total of 30 items were submitted. Both committees then agreed on final list of 5 items based of frequency of responses and importance of the condition. The Evidence Based Committee reviewed the appropriate literature to provide references and support for each item. The Executive Committee of the Orthopaedic Section of the American Academy of Pediatrics (AAP) reviewed the 5 listed items and provided further feedback. POSNA Board of Directors provided further feedback and voted on the final list. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.


Symons S. Rowsell M, Bhowal B, Diass JJ. Hospital versus home management of children with buckle factures of the distal radius:  A prospective randomized trial. J Bone Joint Surg Br. 2001;83:556-560.

Van Bosse HJ, Patel RJ, Thacker M, Sala DA. Minimalistic approach to treating wrist torus fractures. J Pediatric Orthop. 2005 Jul-Aug;25(4):495-500.

Williams KG, Smith G, Luhmann SJ, Mao J, Gunn JD, Luhmann JD.  A randomized controlled trial of cast versus splint for distal radial buckle fracture: An evaluation of satisfaction, convenience, and preference.  Pediatric Emergency Care. 2013 May;29(5):555-559.