Candlestick Fracture (Torus / Buckle Fracture)

What Is It?

A candlestick fracture is another name for a torus fracture (also called a buckle fracture). The term "torus" comes from the Latin word for a round protuberance or bulge - describing what the bone looks like when it buckles. The "candlestick" name comes from the same visual analogy: the cortex bulges outward like wax on a candlestick.

It is an incomplete fracture unique to children, caused by the plastic, less brittle nature of their bones.

Mechanism

Compressive forces (axial loading) cause the cortex to buckle on the compression side rather than fracture completely across the bone. The periosteum and the far cortex remain intact. This is in contrast to:

(a) Normal bone - no injury
(b) Adult transverse fracture - complete failure across the whole bone
(c) Greenstick fracture - cortex fails on the tension side only
(d) Torus/buckle fracture - cortex buckles on the compression side

(See diagram below)

$Types of bony injury showing torus/buckle fracture compared to other fracture patterns$

(Bailey and Love's Short Practice of Surgery, Fig. 32.7: (d) = torus/buckle fracture - note the cortical bulge without complete cortical disruption)

Common Sites

Distal radius (most common - after a fall on an outstretched hand / FOOSH injury) - most frequent pediatric fracture in emergency departments
Distal radius + ulna together
Distal tibia (near the ankle)
Any metaphysis subject to axial loading

Clinical Features

Occurs in children (bones are softer and more pliable)
Mechanism: typically a fall on an outstretched hand
No visible deformity of the limb shape
Soft tissue swelling over the injury site
Point tenderness over the metaphysis
Painless motion at joints proximal to the injury (e.g., elbow and shoulder are normal in an isolated wrist buckle fracture)

Radiology

X-ray findings can be subtle:

Look for asymmetry, bulging, or deviation of the cortical margin at the metaphyseal flare
Soft tissue swelling is usually evident
No angulation, displacement, or rotational deformity - this is a key distinguishing feature
The fracture is confined to the metaphysis (within ~1 cm of the growth plate)

$AP and lateral radiographs of torus fractures of the distal radius and ulna (arrows indicate cortical buckle)$

(Tintinalli's Emergency Medicine, Fig. 141-7: bilateral arrows show subtle cortical buckling at the distal radius and ulna)

Classification - Pediatric Fracture Spectrum

Type	Description
Torus / buckle	Compression cortex buckles; both cortices intact
Greenstick	Tension cortex cracks; compression cortex intact
Plastic deformation	No visible fracture line; bone simply bows
Complete fracture	Both cortices fail

Management

Torus fractures are very stable - they do NOT require reduction.

Setting	Management
ED (distal radius buckle, no deformity/displacement/neurovascular injury)	Volar splint
Follow-up	Orthopedics within 1 week
Healing time	4-6 weeks

Key points:

No reduction needed - the fracture is already aligned
No risk of re-displacement (unlike greenstick or complete fractures)
Does not put the child at higher risk for future fractures
No long-term effect on growth or function when treated appropriately

Why This Only Happens in Children

Children's bone is more plastic and less brittle than adult bone due to:

Higher collagen-to-mineral ratio
Thicker, more elastic periosteum
Active growth plates

Adult bone "cracks like chalk" under the same force that makes a child's bone buckle like Play-Doh.

Sources:

Tintinalli's Emergency Medicine, p. 948
Bailey and Love's Short Practice of Surgery, 28th Ed.
The Harriet Lane Handbook, 23rd Ed., Table 2.2
Children's Mercy - Buckle Fractures in Children

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