Greenstick fracture
1568871
219581170
2008-06-15T23:00:10Z
Jqspyder
7316011
/* Definition */ spelling errors
{{Cleanup|date=October 2007}}
A '''greenstick fracture''' is a broken bone that is most common with children. It is usually a result of one small fall or blow to one side of the body. The term ''greenstick'' is derived from an analogy between the pliable bones of children and the flexible nature of a young twig. It does not usually heal after one week. Greenstick fractures are usually the result of direct [[Blunt force trauma|trauma]] to the bone, and are only "partial" fractures, in which the bone does not completely break through. Often, since these fractures are so stable, a simple application of force using one's thumbs is all that is needed for reduction. Because of children's great capacity to mend their bones, these fractures often have an excellent [[prognosis]]. Greenstick fractures are especially common in children suffering from [[rickets]].
==Definition==
When a [[Sap (plant)|sappy]] (green) twig or branch is bent beyond its failure point, one side tends to break but the other remains in continuity and bends. The bones of children under age 13 are similarly "bendable" and may break with the "greenstick" pattern — one [[Cortex (anatomy)|cortex]] of the bone [[bone fracture|fracturing]] and the other deforming.
Normally the prognosis is very good for this kind of fracture since the thick periosteum will act as a splint and immobilize the defect. Children also have good remodeling capability.
==Incidence==
Extremely common.
==Pathogenesis and risk factors==
The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. [[Child abuse|Non-accidental injury]] more commonly causes spiral (twisting) fractures but a blow on the [[forearm]] or [[shin]] could cause a greenstick fracture.
==Natural history/untreated prognosis==
Greenstick fractures almost always heal. Because part of the bone is in continuity the fracture fragments do not move so the pain from the injury improves quickly and the fracture is stable (increased deformity is not likely). However, most greenstick fractures have angular deformity and this will persist. The bone may remodel (grow straight) but not always and not when the deformity is marked. The other reason to recommend treatment is that the healing bone is weak and the unprotected fracture can be converted to a completely displaced injury if the child falls.
==Clinical features==
The child and/or its caregivers will usually describe significant injury with a bending force, for example a fall or a blow with impact from the side. The limb will be painful and is often swollen and deformed. The child will rarely still be able to use the limb or walk on it; usually it is too sore. Examination will show tenderness and angulation at the fracture site as well as pain on moving the limb or rotating it. Circulation and sensation are usually intact.
==Investigation==
The affected bone and the joints above and below should be [[x-ray]]ed. This will show the characteristic fracture pattern.
==Non-operative treatment==
Standard treatment is closed [[reduction (orthopedic surgery)|reduction]] and [[cast (orthopedic)|cast]] application. The hallmark of a greenstick fracture is angulation at the fracture site and this should be straightened. Because this would be painful, the child should be anaesthetised or the limb made painless with [[regional anaesthesia]]. As noted above, [[Reduction (orthopedic surgery)|fracture reduction]] is straightforward; pressure is applied to the apex of the deformity and the bone straightens. If necessary some [[Traction (orthopedics)|traction]] may also be applied. It is difficult to overstraighten a greenstick fracture because the cortex on the concave side of the bone is still intact and cannot be distracted. Following reduction, the limb is placed in a [[Cast (orthopedic)|cast]]. The cast is usually in place for three weeks or more depending on the state of [[bone healing]]. This is followed by a period of activity restriction and [[Physical therapy|rehabilitation]]. It is not usually necessary to have formal [[physiotherapy]].
==Risks of non-operative treatment==
Inadequate reduction may cause persistent [[deformity]]. Casts that are too tight can cause [[compartment syndrome]].
==Prognosis following non-operative treatment==
Prognosis following non-operative treatment is excellent. Healing of a greenstick fracture is almost universal, so the [[prognosis]] depends on the adequacy of the [[Reduction (orthopedic surgery)|reduction]] and avoiding [[complication (medicine)|complications]] of treatment.
==Operative treatment==
Indications for surgery in a greenstick fracture amount to failure to obtain a satisfactory [[reduction (orthopedic surgery)|reduction]]. Surgery would consist of open reduction; fixation would usually still be by cast rather than internal fixation. This is extremely rare. An open greenstick fracture is also very rare but in that case, surgery to clean up the wound would be needed.
==External links==
* [http://www.wheelessonline.com/ortho/green_stick_frx_of_forearm Greenstick Fractures of the Forearm] Wheeless' Textbook of Orthopaedics
* [http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=249&topcategory=Arm Forearm Fractures in Children] Patient Information from [[AAOS]]
* [http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=125&topcategory=General%20Information Fractures] Patient Information from AAOS
[[Category:Bone fractures]]
[[Category:Injuries]]
[[Category:Traumatology]]
[[fr:Fracture en bois vert]]