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.