This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. Nine-year-old female with complaints of left proximal forearm pain following a trampoline accident concerned for buccal fracture. The patient in this case presented with this radiograph demonstrating a buccal fracture right here involving the distal ulnar diaphysis. Although not commonly used in evaluating for fracture, ultrasound has been performed in this patient. Ultrasound can demonstrate a cortical step-off of the echogenic cortex as seen here consistent with a buccal fracture. This is on a different patient presenting with wrist pain. Buccal fractures are incomplete fractures of the shaft of a lung bone that is characterized by bulging of the cortex as we can see here. They result from trabecular compression due to an axial loading force along the long axis of the bone. Here on our frontal radiograph, we can see the buckling of the distal radial diaphysis and also of the distal ulnar diaphysis. These types of fractures are commonly seen in children aged 5 to 10 years of old due to the elasticity of their bones. In some cases, only the buckling of the cortex are seen without discrete fracture lines such as here in the distal ulnar buccal fracture.

2nd Edition, CASE 08

2nd Edition

Elbow and Forearm

buccal fracture

trampoline accident

ultrasound verification

cortex buckling

axial loading forces