Greenstick fracture

What is Greenstick Fracture?

Greenstick Fracture is a condition when bone bends and cracks rather than breaking. It breaks partially instead of breaking entirely into several pieces and is also termed as “partial fracture.” They are most common in infants and children particularly below the age of 10 years. This category of fracture was found by a British American, Michael Slupecki and John Insall.

Types of Greenstick Fracture

Greenstick fractures are of three types:

Greenstick Fracture of Clavicle

It occurs when the fall happens with hands outstretched or with a direct blow felt on the upper chest or shoulder. The clavicle in human body grows hard and gains complete maturity only after the age of 20 years. Hence the fracture of the clavicle is quite common in children as well as during adolescence.

Greenstick Fracture of Wrist

The fracture is common in the radius or ulna, i.e., the bones in the forearm. It is likely to occur when a child falls on a widely spread arm or palm from a certain height. In case of the radius, the fracture occurs mainly in the proximal, medial or at the distal end of the bone. It can result in the incomplete break along with an arm displacement. But if the force is caused more significantly, then it can cause complete breakage and should be treated with proper attention. An arm cast will be then required for about 4-6 weeks for complete cure.

Greenstick Fracture of Tibia

This type of greenstick fracture happens if a child lands on foot while falling from a height or experiencing a direct blow to the leg. But fracture in tibia is caused if the force is higher than the force which causes a fracture of the ulna and radius. Mainly the third and lower third part of the tibia is mostly affected.

Causes for Greenstick Fracture

As the bones remain soft during childhood, they are softer and more flexible due to high levels of calcium compared to that of adults. Technically, the cause of greenstick fracture is same as that of other types of fractures, i.e., caused by forced impact to the bones due to a fall, direct blow or a twist. Some of the common causes are:

• Falling while playing games such as hide and seek
• Physical activities like running, tumbling and skipping or while playing outdoor games
• Running over uneven and rough lands
• Tripping

Symptoms of Greenstick fracture

Children and infants cannot express their pain in words so they start to wail and their crying cannot be controlled while they feel the intense pain. They tend to guard and protect the injured area which is a prominent sign of their condition. For greenstick fracture, the signs and symptoms may vary depending on the seriousness of the fracture.

• Intense pain at the site
• Bruises or sprains with general tenderness
• Deformity or bend in and around the fractured area along with pain and swelling
• Inability to move the finger
• Pain accompanied by swelling and tenderness when moved.
• Swelling
• Twisted or bent limb
• Simple bruise or redness
• Tendency to guard the injured portion
• Continuity of the pain or feeling of stiffness in the limb after falling or an injury

Diagnosis of Greenstick Fracture

The fracture may go unnoticed resulting in inappropriate diagnosis it causes less pain.

• Thorough check of history and a physical test
• X-rays for the clear identification of the fracture & the doctor compares the injured limb with the uninjured
• Ultrasound test or even a computerized tomography
• Examination of the affected area of the limb or hands to check for tenderness or swelling or redness and any deformity or numbness
• Patient may be asked to move his hands, palms or limbs in different ways to check if any damage is present inside the tissues or nerves

Treatment for Greenstick Fracture

The primary goal is to bring the bones together to their original position and thus allow them to congregate naturally by their formation. It can be done only if the limb is immobilized so that it does not experience any pressure on the area.

• Bone might be pulled apart slightly and then again putting it into its original place. It further can straighten the bone thereby reducing it.
• In case there is a bend, the bones should be repositioned manually in proper alignment usually undergone under proper pain relieving and anesthetic medication under a proper course of medicines and sedatives should be given. Also, general anesthesia may be provided as the patient can feel some pain.
• In maximum cases, the Greenstick fracture is cured while placing it in a cast. The cast keeps the bones in proper position while they start healing and also prevent them from further injury or breaking.
• Doctors may suggest a removable splint for the child’s benefit which works equally well if the wound gets almost cured.
• It is highly advisable to avoid heavy work or activities for at least a few weeks after the splint or cast is removed. The healing time may vary according to the seriousness of the fracture, the nature of the injured bone and even the health history of the child.
• Anti-inflammatory medicines are prescribed at times to redeem the swelling.
• Unfortunately, in some cases, surgery is the only option to cure the fracture.
• In extreme cases, if one needs to be operated, then traction might be recommended post the surgery so that the fracture gets straightened.

Prevention of Greenstick Fracture

Parents must adopt a few steps for preventing Greenstick fracture in their child:

• One should supervise and keep an eye on the child while playing
• While traveling, seat belts should be put appropriately around the child
• The child must be made to wear safety gears while playing
• Adequate calcium must be in the child’s daily diet to make the bones strong

When to call a doctor?

When one experiences the following symptoms, it is recommended to consult a doctor.

• Pain in a limb which is continuing even after a day or two
• Bend in limb or joint is apparently visible
• Inability to lift heavyweight (especially from the section of the affected limb)