Worried about my son's Buckle(Torus) fracture..Please help ?!
Question: Worried about my son's Buckle(Torus) fracture..Please help .?
10 days ago , my son sitting in the stroller fell down from the stairs , and had a cast(plaster) on his right leg .
I took my son to emergency and the doctor there said that he had a buckle(torus)fracture at proximal tibia and that will be healed in 3-4 weeks. I didn't see the x-rays that time.
We then had a follow up appointment after 10 days at another doctor(orthopedic surgeon). He showed us the first x-ray taken 10 days ago and i noted the fracture at proximal tibia as well as bumps on both edges of upper sides of tibia. Dr. said it is a stable fracture.
I wanted to know that what does these bumps on both edges of proximal tibia indicate .?
After 5 mins , there came another doctore, senior than the previous one, and said that this is a cozen fracture and there might be a possiblity of valgus deformity of knee which really made us worried.
Can anybody tell me that what are the chances of having valgus deformity of knee in this type of fracture .?
I am really worried about this and hope someone here would clear my confusions or tell me another group or website where i may ask my question.
also, if you want to ask anything else about this, please let me know.
thanks.Health Question & Answer
I took my son to emergency and the doctor there said that he had a buckle(torus)fracture at proximal tibia and that will be healed in 3-4 weeks. I didn't see the x-rays that time.
We then had a follow up appointment after 10 days at another doctor(orthopedic surgeon). He showed us the first x-ray taken 10 days ago and i noted the fracture at proximal tibia as well as bumps on both edges of upper sides of tibia. Dr. said it is a stable fracture.
I wanted to know that what does these bumps on both edges of proximal tibia indicate .?
After 5 mins , there came another doctore, senior than the previous one, and said that this is a cozen fracture and there might be a possiblity of valgus deformity of knee which really made us worried.
Can anybody tell me that what are the chances of having valgus deformity of knee in this type of fracture .?
I am really worried about this and hope someone here would clear my confusions or tell me another group or website where i may ask my question.
also, if you want to ask anything else about this, please let me know.
thanks.Health Question & Answer
Answers:
Hello,
(Thanks for the email).
A buckle (or torus) fracture is a sort of "squash" fracture. Because a child's bones are still a bit soft, if you apply a "squashing" force in the same line as the bone, the bone will "telescope shut" and bulge. This is what produces the bulge-outs you refer to, something like in this picture, I imagine,... http://www.medscape.com/content/2002/00/...
A 'torus' is a a geometrical doughnut (donut) shape. Perhaps you can imagine one way to produce a donut, - - you might take a short, solid 'tube' of dough and squash the ends vertically together... the tube will squash up, or 'telescope' up, and bulge out into a donut shape.
The bulges you refer to are out-bulgings from the squashing, and represent soft bone that has been 'squeezed' out sideways like toothpaste from a tube.
Another way of looking at the same thing, might be to consider a soft, flat egg-sandwich, corresponding in this case to the top end of the tibia. Press down hard in the center of the sandwich: the egg filling will bulge out sideways in all directions, and the whole sandwich will then take up a much more donut- y shape.
If an equal amount of bone is squeezed out on each side, the bone remains straight, (roughly speaking). However, if the bone is just squeezed out from one side, it can create an angle in the growing bone at that point.
Here is a reference saying roughly the same thing, ... http://orthopedics.about.com/cs/pediatri...
Current research on the web indicates that a child is likely to "grow out" of a 'tibia valgus' angulation of less than 15 degrees, ...
Translation of the article...
<< In 6 out of 7 children with an outward angulation of the tibia caused by injury, the abnormal angle corrected itself on its own! But angles of more than 15 degrees are less likely to self- correct. >>
Original article... (at http://gait.aidi.udel.edu/res695/homepag... )...
[ << "Zoints and MacEwen reviewed the cases of seven children with post-traumatic tibial valga. In six of these patients spontaneous correction occurred. Although improvement was seen in the metaphyseal diaphyseal angle in all cases in which spontaneous correction occurred, compensatory overgrowth of the lateral distal physis was also seen. Valgus deformity in excess of 15 degrees is less likely to spontaneously improve according to Jackson . " >> ]
The whole subject is treated quite well, but in rather technical medical language, here at http://www.medscape.com/viewarticle/4465... To see this, use my Username: bell@phl.org.uk and password: belliger and don't tell anyone... <g>
I will try and translate it back into ordinary speech...
Translation of the article...
<< In the 'classical' buckle fracture, the squeezing on the bone is in exactly the same line as the bone, and therefore crushes both sides equally. This does not create an angle in the healed bone.
<< In an angled buckle fracture, there is squashing but it is not even on both sides, therefore some angulation can occur in the healed bone." >>
Original article...
[ << "There are two types of buckle fractures: the classic buckle fracture, in which there is outward buckling of the cortex (Figures 2A and B); and the angled buckle fracture, in which the cortex is merely angled (Figure 2C). In the classic buckle fracture, axial loading is almost pure and the resultant forces are distributed evenly across the metaphysis. As a result, the trabeculae are crushed along the fracture line (sclerosis) and the cortices at either end bulge outwardly. In some cases, bilateral cortical bulging occurs, while in other cases bulging is unilateral. With the angled buckle fracture, in addition to axial loading, some other force (ie, varus, valgus, hyperextension or hyperflexion) is also at play. This other force tends to lateralize the forces across the metaphysis, and rather than an outward cortical buckling fracture occurring, an angled buckle fracture of the cortex occurs on one side (Figure 2C). As opposed to the other type of buckle fracture, which occurs a short distance from the epiphyseal line, the angled buckle fracture occurs adjacent to the epiphyseal line. If forces that produce the angled buckle fracture are more severe, a frank Salter-Harris type II fracture results. Buckle fractures in general most frequently occur in the wrist, ankle, and elbow. Thereafter, they occur around the knee and the shoulder but much less commonly. >> ]
Of course "valgus" just means, "angled outwards," - - in this case creating a "knock knee" effect, with the ankles further apart than normal.
I would have thought that the chances of a troublesome angled fracture here were quite low, (although I am very distant from the child and from the X-rays), - - and that even if it does occur, it would less than the fifteen degree angle which seems to be growable- out- of.
I see from your e-mail that your son is aged 2,... that is good, the younger the better so far as spontaneous straightening of any deformity is concerned.
IF any angulation develops,... IF it is more than 15 degrees,... and IF it does not look like it is going to straighten by itself,... - - then there are orthopedic procedures to help it straighten as the child grows.
( I think "IF" to the power of 3, - - IF x IF x IF, - - seems pretty unlikely, which is good; to say the same thing mathematically, - - if each "IF" were 50% likely, say, then the total likelihood becomes 0.5 x 0.5 x 0.5 = 0.125 = only 12.5% likely altogether) :-)
I hope this is of some help.
Best wishes,
Belliger (retired uk gp)
belliger@nym.hush.comHealth Question & Answer
(Thanks for the email).
A buckle (or torus) fracture is a sort of "squash" fracture. Because a child's bones are still a bit soft, if you apply a "squashing" force in the same line as the bone, the bone will "telescope shut" and bulge. This is what produces the bulge-outs you refer to, something like in this picture, I imagine,... http://www.medscape.com/content/2002/00/...
A 'torus' is a a geometrical doughnut (donut) shape. Perhaps you can imagine one way to produce a donut, - - you might take a short, solid 'tube' of dough and squash the ends vertically together... the tube will squash up, or 'telescope' up, and bulge out into a donut shape.
The bulges you refer to are out-bulgings from the squashing, and represent soft bone that has been 'squeezed' out sideways like toothpaste from a tube.
Another way of looking at the same thing, might be to consider a soft, flat egg-sandwich, corresponding in this case to the top end of the tibia. Press down hard in the center of the sandwich: the egg filling will bulge out sideways in all directions, and the whole sandwich will then take up a much more donut- y shape.
If an equal amount of bone is squeezed out on each side, the bone remains straight, (roughly speaking). However, if the bone is just squeezed out from one side, it can create an angle in the growing bone at that point.
Here is a reference saying roughly the same thing, ... http://orthopedics.about.com/cs/pediatri...
Current research on the web indicates that a child is likely to "grow out" of a 'tibia valgus' angulation of less than 15 degrees, ...
Translation of the article...
<< In 6 out of 7 children with an outward angulation of the tibia caused by injury, the abnormal angle corrected itself on its own! But angles of more than 15 degrees are less likely to self- correct. >>
Original article... (at http://gait.aidi.udel.edu/res695/homepag... )...
[ << "Zoints and MacEwen reviewed the cases of seven children with post-traumatic tibial valga. In six of these patients spontaneous correction occurred. Although improvement was seen in the metaphyseal diaphyseal angle in all cases in which spontaneous correction occurred, compensatory overgrowth of the lateral distal physis was also seen. Valgus deformity in excess of 15 degrees is less likely to spontaneously improve according to Jackson . " >> ]
The whole subject is treated quite well, but in rather technical medical language, here at http://www.medscape.com/viewarticle/4465... To see this, use my Username: bell@phl.org.uk and password: belliger and don't tell anyone... <g>
I will try and translate it back into ordinary speech...
Translation of the article...
<< In the 'classical' buckle fracture, the squeezing on the bone is in exactly the same line as the bone, and therefore crushes both sides equally. This does not create an angle in the healed bone.
<< In an angled buckle fracture, there is squashing but it is not even on both sides, therefore some angulation can occur in the healed bone." >>
Original article...
[ << "There are two types of buckle fractures: the classic buckle fracture, in which there is outward buckling of the cortex (Figures 2A and B); and the angled buckle fracture, in which the cortex is merely angled (Figure 2C). In the classic buckle fracture, axial loading is almost pure and the resultant forces are distributed evenly across the metaphysis. As a result, the trabeculae are crushed along the fracture line (sclerosis) and the cortices at either end bulge outwardly. In some cases, bilateral cortical bulging occurs, while in other cases bulging is unilateral. With the angled buckle fracture, in addition to axial loading, some other force (ie, varus, valgus, hyperextension or hyperflexion) is also at play. This other force tends to lateralize the forces across the metaphysis, and rather than an outward cortical buckling fracture occurring, an angled buckle fracture of the cortex occurs on one side (Figure 2C). As opposed to the other type of buckle fracture, which occurs a short distance from the epiphyseal line, the angled buckle fracture occurs adjacent to the epiphyseal line. If forces that produce the angled buckle fracture are more severe, a frank Salter-Harris type II fracture results. Buckle fractures in general most frequently occur in the wrist, ankle, and elbow. Thereafter, they occur around the knee and the shoulder but much less commonly. >> ]
Of course "valgus" just means, "angled outwards," - - in this case creating a "knock knee" effect, with the ankles further apart than normal.
I would have thought that the chances of a troublesome angled fracture here were quite low, (although I am very distant from the child and from the X-rays), - - and that even if it does occur, it would less than the fifteen degree angle which seems to be growable- out- of.
I see from your e-mail that your son is aged 2,... that is good, the younger the better so far as spontaneous straightening of any deformity is concerned.
IF any angulation develops,... IF it is more than 15 degrees,... and IF it does not look like it is going to straighten by itself,... - - then there are orthopedic procedures to help it straighten as the child grows.
( I think "IF" to the power of 3, - - IF x IF x IF, - - seems pretty unlikely, which is good; to say the same thing mathematically, - - if each "IF" were 50% likely, say, then the total likelihood becomes 0.5 x 0.5 x 0.5 = 0.125 = only 12.5% likely altogether) :-)
I hope this is of some help.
Best wishes,
Belliger (retired uk gp)
belliger@nym.hush.comHealth Question & Answer
Hello,
Sorry it took so long to get back to you; I was at work on a 24 hr shift.
You have given me the most complicated question I have every recieved, but with all thats included in it not sure what the real question is you need answered.
As for the chance of deformity, you need to remember one thing; doctors are so scared of being sued that they will tell you everything possible and test for the same. If he breezed over this and didn't seem to upset or concerned that would alleviate lots of my concern, especially since he was the only one to mention it.
For more info on what he was talking about, do a Yahoo search of just "valgus" for starters, and read what wikipedia says and go from there increasing your search.
Sorry I could be the help you needed, but specifics on orthopedic questions is quite far from my specalty.
Now I see a physcian has answered your question and I'm sure with much more sage advise than I could ever give, so good luck!!
Health Question & Answer
Sorry it took so long to get back to you; I was at work on a 24 hr shift.
You have given me the most complicated question I have every recieved, but with all thats included in it not sure what the real question is you need answered.
As for the chance of deformity, you need to remember one thing; doctors are so scared of being sued that they will tell you everything possible and test for the same. If he breezed over this and didn't seem to upset or concerned that would alleviate lots of my concern, especially since he was the only one to mention it.
For more info on what he was talking about, do a Yahoo search of just "valgus" for starters, and read what wikipedia says and go from there increasing your search.
Sorry I could be the help you needed, but specifics on orthopedic questions is quite far from my specalty.
Now I see a physcian has answered your question and I'm sure with much more sage advise than I could ever give, so good luck!!
Health Question & Answer