Has your child been diagnosed with a greenstick or torus fracture? These are one of the most common children fractures I see in x-ray.
I rely on my knowledge as a diagnostic radiographer and on the data available in medical studies, so that you can have more precise answers to all your questions about these types of fractures.
If you have any comments or experience to share. just drop us a line in the comments section below this article.🙏
Happy reading!😃
Declaration of financial interest: amazon affiliate links. My complete declaration of the links of interest is in the legal mentions
Last updated: March, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️What is the difference between a greenstick and a torus buckle wrist fractures
Both are types of bone fractures that fall in a category of wrist fracture which are more common in children.
These kinds of injuries are normally not serious fractures, with proper treatment your child will be able to use their hand within 3 to 4 weeks.
I have had parents wonder if their children can go to school after these kinds of fractures.
The answer is YES, unless their pain is a big inconvenience for them, but with a splint on, the pain should have decreased.
▶️What does a greenstick fracture look like?
It happens when something bends a bone enough to crack it without breaking it into multiple pieces.
only the cortex and periosteum are interrupted on one side of the bone while they remain uninterrupted on the other side (Atanelov,2023)
Lateral and AP projects of greenstick fractures of the wrist.
▶️What does a torus (buckle) fracture look like?
While a torus fracture also known as a buckle fracture results from a compression force which causes the outer layers to fail and gold in on themselves creating a bump.
Torus fracture of the left distal radius AP and lateral views (arrow). Image from: Tahir ,2024
▶️Why do these fractures commonly happen more in children? Causes
Most of the greenstick fractures I have x-rayed are in children under the age of 10, however they can as well occur in adults.
🟠The reason being children’s bones are still growing and have different structures to adult’s bones.
🟠They contain more cartilage, which makes them more flexible and less likely to break completely.
🟠Due to their increased compliance, paediatric bones tend to have more bowing and bending injuries under stress that would cause a fracture in an adult bone.
🟠The periosteum in bones is more active, thicker, and stronger in children, which greatly decreases the chance of open fractures and fracture displacement
Atanelov,2023
▶️What really causes greenstick and torus (buckle) fractures?
The common mechanism of injury of both greenstick and buckle fractures is similar.
Most children who come to x-ray claim to have had:
🔴A fall onto an outstretched hand causing these types of fractures.
🔴They also occur due to other types of injury, including motor vehicle collisions, sports injuries, or non-accidental trauma where the child is hit with an object.
🔴Malnutrition, specifically vitamin D deficiency, increases the risk of greenstick fractures of the long bones after a trauma.
Atanelov,2023
▶️What are the symptoms of both types of fractures?
The symptoms of greenstick and torus buckle fractures do not differ to other wrist fractures.
♦️You will feel pain immediately after the injury especially when you move
♦️Bruising at the injured site.
♦️Bent or twisted more than usual.
♦️You will have swelling around the injured wrist.
♦️Difficult bending arm.
▶️Diagnostic for greenstick and torus (buckle) fractures.
When you take your child to the doctor, a physical examination of the wrist will be done.
An x-ray will be requested to provide images that will be used to diagnose the fracture.
X-ray usually shows a bending injury with a fracture line that does not completely go through the bone for greenstick fractures and a bump for torus fractures.
Image showing a minimally angulated greenstick fracture of the radius yellow arrows and torus fracture red arrows: image from (Spierings,2024)
Ultrasound was found to be more sensitive than X-rays for diagnosing these fractures in cases when they are not visible on x-ray.
Pountos,2010
Other imaging such as MRI and CT will only be requested for surgical purposes only, but they are very rare.
▶️What are treatment options for Greenstick and torus buckle wrist fracture in children.
The great news is that the majority of greenstick and buckle fractures can be managed conservatively.
Conservative treatment: immobilisation.
Treatment for these types of fractures are normally non-conservative, rarely you will require surgery. There four types of immobilisations normally used:
1️⃣A rigid below elbow cast
2️⃣Removable splints.
3️⃣Wool and bandage
4️⃣Soft tubular elasticated bandage (Tubigrib)
Regardless of the immobilisation method used, there is no difference in pain scores or analgesic requirements (Pountos,2010)
However, some studies noted that using tubigrip showed improved grip strength and stiffness over the plaster cast and future splint (Pountos,2010)
Greenstick fracture treatment options:
Depending on the degree of angulation and buckle, the first line of treatment will be protecting the fracture site while it is healing.
🟩Immobilization.
Your child will be given a splint to help stabilise the fracture, then after you will be given a short -arm case usually for a minimum of 3 weeks (Patel,2021)
If you have a cast, you may be given an additional sling so that you can occasionally rest your arm in the sling (see Amazon)
Image showing how to put on a sling so that it does not pull on your neck.
How long do you keep the sling, your doctor should have given you instructions on the subject. In general immobilisation, whether in a cast or splint, lasts for 3 to 6 weeks.
🟣Your child is supposed to wear it day and night for 4 weeks to help stop the wrist from moving around while they sleep.
🟣If the degree of angulation is significant, then your doctor will perform a closed reduction before immobilization
🟣In rare cases, greenstick fractures may be treated with splinting if there is only a small amount of angulation, this can allow for splint removal at home while having a shower.
Most greenstick fractures require immobilization, and casting several days after the initial injury, this will decrease the risk of the need to recast due to increasing oedema post fracture (Atanelov,2023)
Greenstick fractures can only be complicated by a median nerve injury (Patel,2021). Following delayed diagnosis, surgical exploration may be performed.
The only difference between these two fractures is that with greenstick fractures.
Your child will need some type of orthopaedic follow-up due to their unstable nature and increased likelihood of refracture and displacement compared to buckle.
Torus (buckle) fracture treatment management.
The treatment and follow-up of torus fractures varies from soft immobilizations to a plaster cast.
So, when you go to the emergency department, usually this treatment algorithm will be followed. Tahir,2024
From: Tahir,2024
The main goals of treatment are comfort for the patient as well as reassurance for their parents
Torus fractures are usually managed with a removable splint supplied in A&E and worn for 3 weeks.
There is no need for fracture clinic follow-up or repeat radiological imaging once you are given adequate information at the time of diagnosis unless your case is different.
🟣 Immobilisation in a removal splint or circumferential cast
Some studies prefer the use of removable splints with or without radiological and clinical follow-up (Fitzgerald,2021)
Unfortunately, some current practice conflicts with the studies and there is no guideline which highlights all the evidence as one clear, concise management protocol.
So, you will find that different hospitals have their own protocols they follow which are not so different from what is normally done.
Surgical treatment: operation= very rare
Over the years of my practice, I have not seen a surgical procedure for these kinds of fractures.
When it does occur, it’s because there are other associated problems with your case. If your bones move, the surgeon will immobilize your fracture by using an external fixation device.
Image from mayo clinic .org
With external fixation, a metal frame outside your body immobilizes the fracture with two or more pins that pass through your skin and into the bone on either side of the fracture.
As I have said these are very rare cases, so do not worry, follow your doctor’s instructions and your child will be in position to use their hand before you know it.
▶️Will your child need rehabilitation or physiotherapy exercises?
Children rarely are prescribed physiotherapy sessions because the younger they are it becomes less relevant.
They may not follow instructions, and they usually get on with their activities as quickly.
You only need to give your child caution advice as the healing is taking place to be very careful as they move the hand.
After removing a splint, they can start using their hand naturally within a few weeks.
Only when they find it difficult to use the injured hand or the hand has become very stiff, then physiotherapy may be appropriate.
For any concerns always consult your doctor if a physiotherapy is needed, then he will recommend one
▶️Greenstick and torus (buckle) wrist fracture healing timeline.
These fractures will heal with minimal or no complications and do not require follow-up in a face-to-face trauma or fracture clinic.
| Stages | Recovery timeline |
| You have less pain | A few days |
| Immobilisation in the splint | 3 weeks for torus |
| Immobilisation in the cast greenstick fracture | 6 to 8 weeks for greenstick |
| Greenstick fracture complete healing or well under way | 4-6 weeks |
| Buckle fracture complete healing or under way | 3 to 4 weeks |
| You can gradually use your hand to eat and dress | Immediately |
| You can resume carrying weights like a dumbbell. | Gradually where there is no longer any splint or cast |
| Resume all previous physical activities such as swimming. | Gradually as longer as the wrist is no longer immobilised. ♦️ For children it may take them time to go back to using the arm quicker. ♦️Swimming does not cause strain on the wrist so as soon as your child feels comfortable to do so after 6 weeks. ♦️They should avoid doing PE until 6 weeks after the injury. |
| Complete healing for both without any discomfort. | 6 to 8 weeks, If after the given weeks the wrist is a little sore and stiff after being used, the splint can be used for comfort. |
Healing time and recovery after a greenstick and torus fractures of the wrist.
In summary both these types of fractures recover quickly and well, with no after effects or complications within a few weeks.
Very rarely, this fracture may shift and require further immobilisation or surgery. Occasionally a small deformity may remain with one forearm not perfectly symmetrical to the other but this rare.
We have come to the end of this article, wishing you a quick recovery!🙋
📚Sources:
Pountos I, Clegg J, Siddiqui A. Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study. J Child Orthop. 2010 Aug;4(4):321-6. doi: 10.1007/s11832-010-0269-3. Epub 2010 Jul 2. PMID: 21804894; PMCID: PMC2908342.
Patel DS, Statuta SM, Ahmed N. Common Fractures of the Radius and Ulna. Am Fam Physician. 2021 Mar 15;103(6):345-354. PMID: 33719378.
Fitzgerald E, Mannion J, Boran S. Management of “torus” or “buckle” fractures of the distal radius: a systematic review. Ir J Med Sci. 2022 Oct;191(5):2311-2318. doi: 10.1007/s11845-021-02801-1. Epub 2021 Nov 22. PMID: 34807352.
Tahir A, Naji O, Khawar H, Iqbal MJ. Torus fractures – diagnosis and management. Br J Hosp Med (Lond). 2024 May 30;85(5):1-8. doi: 10.12968/hmed.2023.0336. Epub 2024 May 24. PMID: 38815969.
Atanelov Z, Bentley TP. Greenstick Fracture. 2023 Apr 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30020651.
Spierings JF, Willinge GJA, Schuijt HJ, Smeeing DPJ, Kokke MC, Colaris JW, Goslings JC, Twigt BA; Collaboration group. Direct discharge for children with a greenstick or torus fracture of the wrist is a non-inferior satisfactory solution to traditional treatment. Eur J Trauma Emerg Surg. 2024 Dec;50(6):2663-2671. doi: 10.1007/s00068-023-02391-w. Epub 2024 Jan 13. PMID: 38217672; PMCID: PMC11666698.