Greenstick Fracture

GREENSTICK FRACTURE

Definition

Get a fresh, young tree branch. Then break it. You will notice that the break will not go thru. One side will be broken and the other side will be bent. It is an incomplete break. Just like the greenstick fracture. It was discovered by a British-American orthopedist, John Insall and a Polish-American orthopaedist, Michael Slupecki.

The bend is referred to as an angulation.  The hump from the angulation may be dorsal, meaning it is seen at the back of the forearm. It may also be volar, which means that the hump is at the side of the forearm that one sees when looking at the palm. Usually, there will not be just a bending force, but a rotating force as well, which means that not only did the bone curve a little, it also twisted along the bone's axis.

Greenstick fracture is an incomplete break in a young and soft bone. Mostly, it happens to children and infant whose bones are soft and quite flexible, unlike adults whose bones are brittle and breaks easily. Children’s bones have more tendencies to bend and break only at the other side. That same force when applied to an adult tends to break their bone completely. The three basic forms of a greenstick fracture: a transverse fracture, torus or buckling fracture and the bow fracture. The prognosis for this kind of fracture is good, with healing time at approximately three weeks when promptly diagnosed and treated.

Greenstick fracture symptoms

This kind of fracture may be difficult to diagnose as the signs and symptoms may not show and has no manifestation unless the child begins to complain pain. Swelling, bending or twisting may also appear on the affected limb and there is decreased range of motion on the fractured limb. Sometimes, this fracture heals alone without knowing it exists. Children oftentimes are afraid to tell what happened because of the fear to experience more pain. Fever may also be experienced with the injury.

Greenstick fractured wrist

These fractures are usually either greenstick fracture of distal radius and ulna or greenstick fracture of mid-third of radius and ulna. It tends to occur in children who fell on an outstretched arm. When only one bone is broken, the integrity of both proximal and distal joints should be checked. If there is a minor degree of dorsal angulation, reduction is unnecessary and remolding will take place as the child grows. Reduction involves slow and constant pressure to reduce the deformity, and is applied until the intact dorsal cortex is broken. Failure to break the cortex may result in increasing deformity while on cast. The forearm is gently rotated into supination. A long arm cast is applied, and kept for 4 to 6 weeks.

Greenstick fractured radius

 The radius and the ulna are the bones of the forearm.  Fractures on the arm may occur on the distal, medial or proximal end of the bone. Greenstick fracture of the radius and ulna are usually shown by an incomplete break with displacement or angulation of the arm.  Greater force may cause complete break and therefore must be given proper medical attention.

Greenstick fracture causes

Children love to play. They run, hop, skip, jump, and tumble. If the child fell on an outstretched arm, the result would be a greenstick fracture. This is so because it is our body’s natural reaction to stretch out our arm when we fall, to prevent our head or body from hitting the floor. A blunt trauma also causes such a fracture.

Greenstick fracture diagnosis

When a child had an accident and found to have a slight deformity on the limb, the doctor may suspect a greenstick fracture. However, x-ray will be taken on both limbs to be certain and to compare the injured from the uninjured limb. Most greenstick facture can be shown in an x-ray, but some are difficult to see as the children’s bones are still soft.  This is a unique characteristic of this fracture. It is hardly evident on an x-ray plate. An ultrasound or computerized tomography scan will be suggested for better imaging and diagnosis. It has to be explained that this is not a painful procedure and it will not take long to gain the child’s trust and cooperation.

Greenstick Fracture Treatment  

Greenstick fracture needs immobilization and must be bent back to its original position so that the bone can grow back together. As long as the area is kept strictly immobile in a plaster cast, the fracture will heal correctly.  In some cases, the bone must be broken down completely for better alignment. Anaesthetics will be given locally, so the child will fell no pain during the procedure. Casting the limb is the perfect solution to keep the bone still. A splint may be recommended depending on the condition of the bone as seen in the x-ray. Children as we all know are active and casting may give them irritation and discomfort. However, casts for children comes in variety of colors and are water resistant, giving children some freedom to play and be comfortable. It is also encouraged that children will take less strenuous activities while on cast to prevent further damage on the limb. Swimming is prohibited to prevent softening of the inner layer of the cast making it soft and result to the displacement of the bone. Series of x-ray will be done to monitor the healing of the bone. Normally, it will take 5 weeks or earlier as the children’s bones heal faster because their bones are still developing. The child's cast or splint may be removed or replaced with a smaller cast in as little as three to four weeks. After the cast is removed, the child must undergo rehabilitation for muscle strengthening through home physical therapy. Casts are the most common way to keep a bone still, but your doctor may decide that a removable splint may be used instead so that the child might be able to take it off briefly for a bath or shower.

broken ankle

BROKEN ANKLE

What is broken ankle?

Any fracture that happen in the distal end of the tibia and the fibula, and the talus bone of the foot, is called a broken ankle. These three bones forms the ankle joint and the talus is the only bone that is a part of the ankle joint. Tibia and fibula are parts of the lower leg. Broken ankle is a very common injury and the severity of the fracture varies. Ankle fracture may be partial, or incomplete, open or closed which may be a result for fall, collision/impact, or accident. Thorough assessment and an x-ray examination and/or CT scan, is done by an orthopedic doctor to review the injury and the extent of damage to the nerves and surrounding tissues.

Signs and Symptoms

These common signs and symptoms for broken ankle can be observed:

·         Pain to touch with limited movement of the ankle

·         Swelling and/or bruising on the affected area

·         Inability to walk or stand and bear weight on the ankle

·         Numbness or tingling sensation on the affected ankle

·         Deformity around the ankle

·         Broken skin with visible bone particle

Broken ankle or Sprained ankle?

In a broken ankle, the bone is fractured. In a sprained ankle, the ligaments are over-stretched or torn. The signs and symptoms are often similar but here are some hints in distinguishing the difference between the two.

1.    What caused the injury? If your ankle gets a twist or if you lost your balance as you stepped on an uneven surface, it would probably be a sprain. Heavy impact causes bone break.

2.    If your ankle swells but you are still able to stretch it, that’s an ankle sprain.

3.    If the pain is severe, accompanied by swelling, bruising and tenderness, that’s a broken ankle.

4.    Numbness is indicative of broken bone.

5.    Stand up, take a few steps. If you are able to walk, it indicates that you have a sprained ankle.

6.    Look at the affected area. If the joint appears kinked, or uneven, the bone must have been broken.

7.    Try to make the injured person move the joint. A broken ankle cannot be moved, a sprained ankle can be moved even if it is painful.

8.     Seek professional advice to be certain of the injury acquired.

Treatment for a broken ankle

Anyone with a broken ankle must be checked by an orthopaedic doctor for the treatment plan to be established.  The first aim is to minimize the swelling to control the pain and minimize damage to surrounding tissues. After the x-ray, the doctor can tell how bad the fracture is.

Splinting of the ankle is done initially to immobilize the fracture and it will be kept in place for a few days to give room if the swelling persists. The ankle will be aligned properly prior to splinting. If the swelling subsides, casting will be done. Casts are made either of plaster or fiberglass.  Plaster cast molds better with the skin and is widely use to hold the bone in place. However if the fracture is unstable and some healing has already taken place, a fiberglass cast may be used. It is lighter and tougher to use.

The whole body will not be immobilized, just the fractured ankle. Crutches are used to assist in weight bearing as the ankle will not be used for weeks or months depending on the fracture.  

For the severe cases of broken ankle, surgery is required. The maintenance of the proper alignment of the fractured ankle is of utmost importance for the ankle to heal and be utilized as it was before.

Broken ankle surgery

A general anaesthesia will be given to the patient, and then a cut on the skin near the ankle will be done. Special screws and plates will be used to put the bones together and hold it in place while the bone heals. Then, the skin will be fixed with the use of stitches. A temporary plaster cast will be molded just below the knee up to the toes to secure the ankle in proper alignment and keep it immobile. The wound may be painful and the doctor may give painkillers to ease the pain as well as antibiotics to prevent infection. The surgeon who performed the operation will give instruction as to when the ankle may be moved. Some would prefer to get the fractured ankle moving before sending the patient home in around 2-3 days. Appointment will be scheduled. In 10 days, the stitches will be removed and the ankle will be in plaster cast for approximately 6 weeks. For the first 2 weeks, the affected leg should be elevated at rest several times a day to minimize the risk of further swelling as the cast may impede with the circulation once the ankle swell. Crutches may be used to move around with support, avoiding weight on the fractured ankle.

Once at home, utmost care for the fractured ankle should be done. Plaster cast should not get wet, cut, or pressed on. Nothing should be put underneath the cast and the skin inside should not be scratched by anything. If the toes get blue, swollen, and cannot be moved, or at the presence of numbness or severe pain, go back to the hospital immediately.

The screws and plates may or may not be removed but if it becomes uncomfortable, it may be removed 18 months after the operation. If the plaster cracks, or becomes soft and loose, it should be brought back to the plaster technician.

Broken ankle recovery

If the ankle break is clean, no shifting of the bone and doesn’t require surgery, the broken ankle will heal within a six week period with proper medical management. A repair with the use of invasive surgery would have the broken ankle heal in about eight to 10 weeks. For this long period of recovery, you will need a lot of patience, entertainment, emotional support, lots of pillows, easy access to food and drinks, lots of strength, pain medication and a bath chair. Do not attempt to walk unless your doctor told you so.

Broken ankle rehabilitation

Rehabilitation is very important. When your physician said that you may start moving your ankle, physical therapy and home exercises are available and you should start doing it regularly.

Eventually, you will also start doing exercises to strengthen the surrounding muscles of the ankle. It may take several months for the muscles around your ankle to get strong as before the injury took place. Even after the fracture has healed,an ankle brace may still be worn for several months. Both of your ankles support almost all of your body weight, so it is very important getting them back to full strength again. Here are some of the therapeutic exercises for the recovering ankle:

Ankle Rotations

This exercise helps move the ankle joint, makes good circulation and loosen ligaments that have been inactive while on cast. Sit on a chair, hold your leg just above your injured ankle crossed over your healthy leg. Slowly rotate your foot at the ankle, turning it in circles. Do only as much rotation and stretching you feel comfortable with. If you feel pain, stop and rest.

Towel Scoop

To help achieve range of motion in your foot, sit on a chair barefooted and a hand towel on the floor in front of you. Sit on a surface and use your injured foot to scoop the towel from side to side, keeping your leg still. Do this several times a day.

Wall Stretch

Wall stretches can help the ankle and the muscles associated with it. Stand several feet away from a wall, pressing your hands to it. As if you are trying to push and walk through the wall, with the injured foot on the floor and knee straight behind the healthy foot with knee bent. You should feel a stretch. Hold this stretch for 10 to 15 seconds. Stop if you feel pain.