Greenstick fracture

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Greenstick fracture
Gruenholzfraktur - Unterarmfraktur.jpg
Greenstick fractures on X-ray.
Specialty Orthopedics
Pediatrics

A greenstick fracture is a partial bone break that typically occurs in children due to their more flexible and resilient bone composition. This fracture pattern is characterized by a break on one side of the bone while the other side remains intact and bends, similar to breaking a young, green tree branch. Greenstick fractures most commonly affect the long bones of the forearm (radius and ulna) but can also occur in other long bones throughout the body. Treatment generally involves immobilization with a cast to allow proper bone healing, though in some cases, it may be necessary to realign the bone before casting.

Contents

Signs and symptoms

Children presenting with greenstick fractures typically exhibit localized pain, swelling, and tenderness over the affected area, with notable deformity that may be less pronounced than in complete fractures. [1] The patient often presents with a history of fall or trauma and demonstrates limited range of motion in the affected limb, accompanied by reluctance to use or bear weight on the injured body part. Physical examination usually reveals point tenderness, mild to moderate angulation, and intact soft tissues without complete displacement of the bone fragments. Unlike complete fractures, crepitus (grating sensation) is typically absent due to the partial nature of the break, and there may be preservation of some periosteal continuity on the intact side of the bone. Pain is usually significantly less than other types of fractures, but in a young child, may still be very distressing. [2]

On the side of the fracture that underwent tension, imaging may show bone cortex disruption. On the side that underwent compression, cortex may bulge outward, similar to a torus fracture. [1]

Risk factors

The major risk factor for a greenstick fracture is young age. Children have softer bones than adults, and are also frequently engaged in sports and other activities that result in limb injury. [2]

The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a greenstick fracture.

Diagnosis

Greenstick fractures are usually identified with ease on X-ray of the affected limb, showing a long bone fracture that does not cut all the way through. [2]

Treatment

Treatment of greenstick fractures typically begins with reduction (realigning bone segments) if the bone portions on either side of the fracture form an angle, as opposed to being straight and already aligned. This is followed by the application of a well-molded cast that immobilizes the joints above and below the fracture site. A follow-up X-ray should be performed 7-10 days after cast application, to ensure proper bone alignment and healing progression. Occasionally, to correct an angular deformity, more advanced techniques may be necessary to assist bone remodeling. [3]

Some experts recommend the use of simple splinting rather than a cast. [1]

Fossil record

Evidence for greenstick fractures found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. Greenstick fractures (willow breaks) have been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis. [4]

Greenstick fractures are found in the fossil remains of Lucy, the most famous specimen of Australopithecus afarensis , discovered in Ethiopia in 1974. Analysis of bone fracture patterns, which include a large number of greenstick fractures in the forearms, lower limbs, pelvis, thorax and skull, suggest that Lucy died from a vertical fall and impact with the ground. [5]

Related Research Articles

<span class="mw-page-title-main">Ulna</span> Medial bone from forearm

The ulna or ulnar bone is a long bone in the forearm stretching from the elbow to the wrist. It is on the same side of the forearm as the little finger, running parallel to the radius, the forearm's other long bone. Longer and thinner than the radius, the ulna is considered to be the smaller long bone of the lower arm. The corresponding bone in the lower leg is the fibula.

The forearm is the region of the upper limb between the elbow and the wrist. The term forearm is used in anatomy to distinguish it from the arm, a word which is used to describe the entire appendage of the upper limb, but which in anatomy, technically, means only the region of the upper arm, whereas the lower "arm" is called the forearm. It is homologous to the region of the leg that lies between the knee and the ankle joints, the crus.

In human anatomy, the extensor carpi ulnaris is a skeletal muscle located on the ulnar side of the forearm. The extensor carpi ulnaris acts to extend and adduct at the carpus/wrist from anatomical position.

<span class="mw-page-title-main">Splint (medicine)</span> Medical restraint to keep body part in place

A splint is defined as "a rigid or flexible device that maintains in position a displaced or movable part; also used to keep in place and protect an injured part" or as "a rigid or flexible material used to protect, immobilize, or restrict motion in a part". Splints can be used for injuries that are not severe enough to immobilize the entire injured structure of the body. For instance, a splint can be used for certain fractures, soft tissue sprains, tendon injuries, or injuries awaiting orthopedic treatment. A splint may be static, not allowing motion, or dynamic, allowing controlled motion. Splints can also be used to relieve pain in damaged joints. Splints are quick and easy to apply and do not require a plastering technique. Splints are often made out of some kind of flexible material and a firm pole-like structure for stability. They often buckle or Velcro together.

<span class="mw-page-title-main">Colles' fracture</span> Type of distal radius fracture

A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards. Symptoms may include pain, swelling, deformity, and bruising. Complications may include damage to the median nerve.

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. An open fracture is a bone fracture where the broken bone breaks through the skin. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture. Most bone fractures require urgent medical attention to prevent further injury.

<span class="mw-page-title-main">Orthopedic cast</span> Medical aid for the treatment of bone fractures

Orthopedic casts or just casts are a form of medical treatment used to immobilize and support bones and soft tissues during the healing process after fractures, surgeries, or severe injuries. By restricting movement, casts provide stability to the affected area, enabling proper alignment and healing of bones, ligaments, and tendons. They are commonly applied to the limbs but can also be used for the trunk, neck, or other parts of the body in specific cases. Orthopedic casts come in various types and designs, tailored to the nature and severity of the injury, as well as the patient's needs. Advances in medical techniques have made casts more comfortable, effective, and versatile, allowing for both weight-bearing and non-weight-bearing options.

<span class="mw-page-title-main">Distal radius fracture</span> Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

<span class="mw-page-title-main">Galeazzi fracture</span> Medical condition

The Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radioulnar joint. It classically involves an isolated fracture of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the distal radio-ulnar joint; the injury disrupts the forearm axis joint.

<span class="mw-page-title-main">Madelung's deformity</span> Type of malformation of the wrist bones

Madelung's deformity is usually characterized by malformed wrists and wrist bones and is often associated with Léri-Weill dyschondrosteosis. It can be bilateral or just in the one wrist. It has only been recognized within the past hundred years. Named after Otto Wilhelm Madelung (1846–1926), a German surgeon, who described it in detail, it was noted by others. Guillaume Dupuytren mentioned it in 1834, Auguste Nélaton in 1847, and Joseph-François Malgaigne in 1855.

<span class="mw-page-title-main">Patella fracture</span> Medical condition

A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments.

<span class="mw-page-title-main">Triangular fibrocartilage</span> Anatomical feature in the wrist

The triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).

<span class="mw-page-title-main">Monteggia fracture</span> Medical condition

The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. It is named after Giovanni Battista Monteggia.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates it is not used. In those cases, forelimb plus joint is used.

<span class="mw-page-title-main">Supracondylar humerus fracture</span> Medical condition

A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.

A child bone fracture or a pediatric fracture is a medical condition in which a bone of a child is cracked or broken. About 15% of all injuries in children are fracture injuries. Bone fractures in children are different from adult bone fractures because a child's bones are still growing. Also, more consideration needs to be taken when a child fractures a bone since it will affect the child in his or her growth.

<span class="mw-page-title-main">Ulna fracture</span> Medical condition

An ulna fracture is a break in the ulna bone, one of the two bones in the forearm. It is often associated with a fracture of the other forearm bone, the radius.

<span class="mw-page-title-main">Olecranon fracture</span> Medical condition

Olecranon fracture is a fracture of the bony portion of the elbow. The injury is fairly common and often occurs following a fall or direct trauma to the elbow. The olecranon is the proximal extremity of the ulna which is articulated with the humerus bone and constitutes a part of the elbow articulation. Its location makes it vulnerable to direct trauma.

<span class="mw-page-title-main">Radioulnar synostosis</span> Abnormal fusion of the radius and ulna bones of the forearm

Radioulnar synostosis is a rare condition where there is an abnormal connection (synostosis) between the radius and ulna bones of the forearm. This can be present at birth (congenital), when it is a result of a failure of the bones to form separately, or following an injury (post-traumatic).

<span class="mw-page-title-main">Torus fracture</span> Common type of fracture in children

A Torus fracture, also known as a buckle fracture is the most common fracture in children. It is a common occurrence following a fall, as the wrist absorbs most of the impact and compresses the bony cortex on one side and remains intact on the other, creating a bulging effect. As the bulge is only on one side of the bone, this injury can be classified as an incomplete fracture. The compressive force is provided by the trabeculae and is longitudinal to the axis of the long bone, meaning that the fracture itself is orthogonal to that axis. The word "torus" originates from the Latin word "protuberance."

References

  1. 1 2 3 Patel, Deepak S.; Statuta, Siobhan M.; Ahmed, Natasha (2021-03-15). "Common Fractures of the Radius and Ulna". American Family Physician. 103 (6): 345–354. ISSN   1532-0650. PMID   33719378.
  2. 1 2 3 Boutis, Kathy (2020). "Chapter 141: Pediatric Orthopedic Emergencies". Tintinalli's Emergency Medicine: A Comprehensive Study Guide (9th ed.). McGraw-Hill Education.
  3. Rhodes JT, Miller S, Skinner A, Tagawa A, De S (2025). "Chapter 26: Orthopedics". Current Diagnosis & Treatment: Pediatrics (27th ed.). McGraw Hill.{{cite book}}: CS1 maint: multiple names: authors list (link)
  4. Molnar, R. E. (2001). "Theropod paleopathology: a literature survey". In Tanke, Darren; Carpenter, Kenneth (eds.). Mesozoic Vertebrate Life. Indiana University Press. pp. 337–363. ISBN   978-0-253-33907-2.
  5. Kappelman, John; Ketcham, Richard A.; Pearce, Stephen; Todd, Lawrence; Akins, Wiley; Colbert, Matthew W.; Feseha, Mulugeta; Maisano, Jessica A.; Witzel, Adrienne (22 September 2016). "Perimortem fractures in Lucy suggest mortality from fall out of tall tree". Nature. 537 (7621): 503–507. Bibcode:2016Natur.537..503K. doi:10.1038/nature19332. PMID   27571283. S2CID   4402700.