IS case 531: Subtle torus fracture of the distal radius

Alok Bhatt, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-11


Patient is a 10-year-old female who was playing and fell on her left wrist; she was brought to the emergency room complaining of left wrist pain.


Initial radiographs of the wrist in the emergency room revealed a subtle irregular contour to distal radial metaphysis. Follow-up films approximately one month later revealed periosteal reaction along the same area, consistent with healing fracture.


Subtle torus fracture of the distal radius


Fractures in children are different from fractures in adults mainly because bones in children are more pliable and have a greater tendency to deform prior to breaking. As a result, incomplete fractures in children are more common than adults. The incomplete fracture might be seen on radiographs as a bowing deformity, an incomplete fracture along the cortex of the convex margin of bowing, or, as in this case, a buckling of the cortex along the concave margin of bowing. Buckling of the cortex is also known as a torus fracture, "protuberance" or "little hill."

Another difference in children bones and adult bones is that children bones heal very quickly, and periosteal reaction is seen radiographically as early as 7 to 10 days after initial injury. This can be used for confirmation that a fracture was indeed present on prior radiograph when a questionable fracture is present due to a subtle irregularity in contour of the cortex.


  1. Donnelly LF. Pediatric Imaging: The Fundamentals. Philadelphia: Saunders, 2009.

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