Greenstick Fracture

What is Greenstick Fracture?

Greenstick fracture is a mild bone fracture commonly seen in young children. This kind of fracture is characterized by a bend or partial break of the bone. The bone fracture occurs the same way you would bend a green branch of tree.

When you take a young twig and try to bent or break it, you realize that part of it will break while the other side will remain stressed out but it won’t break. This is the analogy behind Greenstick facture. ¹

A majority of greenstick fractures are seen in children who are less than 10 years old. This form of bone fracture is found in children because they tend to have softer, more flexible bones than those of adults that are brittle.

Types

Greenstick fracture is one form of pediatric fractures. In pediatric fractures, they are grouped as complete and incomplete.

Complete fracture involves the bone structure breaking completely, but with incomplete fracture, only part of the bone breaks and another remains unbroken. Incomplete fractures occur in three basic forms:

Greenstick fracture

It is a transverse fracture involving the cortex and it extends to reach the midportion of a bone. It is oriented along the bone’s longitudinal axis and does not disrupt the opposite cortex, or it causes minimal disruption to the opposite cortex.

Buckling or torus fracture

It is another form of pediatric incomplete fracture. It is caused by impaction. This fracture occurs due to a force that acts on the bone’s longitudinal axis. Typically, torus or buckling fractures are as a result of a fall that acts on an outstretched arm. These fractures are associated with the distal radial metaphysic.

Bow fracture

It is the third form of incomplete fractures and it involves curving of the bone along its longitudinal axis.

Symptoms

The signs and symptoms of greenstick fracture depend on the severity. Sometimes, mild fractures could be mistaken for something else like a bruise or sprain while severe form of the fractures may result in deformity and significant amount of pain and swelling.

Certain features of greenstick fracture tend to be similar to the ones you find with standard long bone fractures. These features are such as:

• Bruises
• Redness and tenderness
• Pain within the fractured area
• Restricted movement of the affected area
• Inflammation and swelling

Greenstick and torus fractures are more stable because part of the bone does not break. In greenstick and torus fractures, the acute pain as well as deformities witnessed in other fractures tend to be minimal and at other times are absent.

Causes

The fracture is commonly caused by a forceful impact on the body. The bend and partial breaking of the bone may be due to:

• A fall
• A blunt injury like a blow

Children participating in sports and indulging in play activities are more likely to suffer falls that could cause greenstick fractures. The fracture mostly occurs on arm bones because it is natural for children and even older people to extend their arm to support their body when they are falling.

Diagnosis

Parents and even doctors may find it difficult to detect and diagnose this kind of fracture because it does not manifest in the same way as the standard bone fractures.

Also the symptoms tend not to be exactly as those of other bone fractures. Again, it is difficult to distinguish this fracture from other conditions like a soft-tissue injury for example, a sprain or bad bruise.

A doctor will use diagnosis tests such as CT scans and X-rays to detect the problem.

X-ray images of the uninjured limb may be required so that they are used to compared with the images for the injured limb. The reason why comparison may be helpful is because, it could reveal bone abnormalities that are not necessarily related to the fracture, and which could otherwise have remained undetected.

It is important to mention that at times, greenstick fractures occurring in soft bones of children might not show up clearly in X-rays. A doctor may therefore, order for a more reliable test such as computerized tomography (CT) scan. Also, ultrasound may provide better images.

Treatment

In treating greenstick fractures, doctors will try to subjugate the fracture by mildly pulling the affected bone apart (just a little bit, and gently) and then push it into position. This helps straighten it to look as it was before the fracture.

Casts

A doctor will put a cast on the affected limb and immobilize it so that there is no movement that could cause further harm on the limb. The cast will help the bone to start growing back and ensure that complete healing of the fracture is achieved.

Casts are considered the standard treatment methods for restricting the motility of bone. Buckle fractures are treated using casts that may be placed below or after the elbow, in case of a fracture occurring on upper limbs.

Splint

Doctors, at times may recommend the use of a removable splint in case they feel it can offer the same treatment benefits. A removable splint is an ideal option to a child because it can be taken off when the child is showering or bathing. Fractures involving the distal radius in children respond well to treatment when the splints are used.

Surgery

While most greenstick and torus fractures will heal after they have been subjugated and a cast placed, in the event that healing does not occur properly, a surgery may be an option.

Medications

To help in pain relief, a doctor may prescribe pain management drugs to the child.

Home Care

When a child has been put a cast, boot, or splint on the limb, you may want to ensure the following home care tips and advice are followed during the healing process:

• To help relieve pain, the child may be prescribed medications for pain and swelling. You may also give the child OTCs for pain relief as has been directed by a doctor.
• If your child has kidney disease or chronic liver disease, talk to your doctor before you use any medications. The same applies if the child had had stomach ulcers and gastrointestinal bleeding before.
• In children who are less than 6 months old, you should not use ibuprofen as a pain reliever medications because of the inherent side effects
• You should not give your child aspirin in an attempt to manage pain
• If the child has been given a cast or splint, he or she should avoid putting weight on it to prevent breakage
• During the first 48 hours, you may want to keep the leg of the child raised when they are lying down or sitting. This is in case the facture has occurred on the lower limb.
• Make sure the boot, splint, or cast is kept dry all the time. When bathing, large plastic bags may need to be used. The bags may be taped or held with a rubber band around the cast or splint. And, because even with the plastic bags, water can still leak, it is important to keep the cast or splint away from water. In the event that the cast or splint becomes wet, you can use a hair-dryer to dry it, but set it on cooling mode. The dry cool air (not hot air) coming from the dryer is able to expel the moisture on the cast or splint.
• Ice packs may be applied on the injured area, especially on the first day. You can apply the ice after every 2 hours for around 20 minutes. On the second day, you can still use the ice pack about 3 to 4 times. Ice packs help ease pain and swelling. However, don’t place the ice directly on skin because it could result in skin burn. Use a clean clothing material to wrap it before placing the ice on the affected area. You can put the ice pack directly on the splint or cast, but you have to be careful because the melting ice could make the splint or cast to become wet.

Reference List

1.  http://www.primehealthchannel.com/greenstick-buckletorus-fracture.html
2.  https://www.drugs.com/mcd/greenstick-fractures
3. https://www.fairview.org/HealthLibrary/Article/116128EN
4. https://en.wikipedia.org/wiki/Greenstick_fracture
5. http://www.mayoclinic.org/diseases-conditions/greenstick-fractures/home/ovc-20200854
6. Greenstick Fracture available at https://radiopaedia.org/articles/greenstick-fracture