Greenstick Fractures

Fig. 8.7. Greenstick fracture of the radius with complete fracture of the ulna...

Low energy bending injuries may produce plastic deformation (bowed fractures) or, if a cortical break is produced, it may not propagate fully across the bone. The cortex and periosteum on the compression side may be intact or undisplaced, resulting in a greenstick fracture. 

Radiographs show a torus or greenstick fracture of the proximal tibial metaphysis. The fracture line may be poorly visible or even incomplete, running from the medial (tension) side. Occasionally, there may be valgus angulation and the fibula may also be fractured. 

Fig. 19.37. Greenstick fracture of the distal radius, with volar angulation...

A complete fracture occurs when there is discontinuity between two or more bone fragments, while with incomplete fractures, a portion of the cortex remains intact. Incomplete fractures are common in children due to the increased elasticity of the bone. Greenstick and buckle fall into the group of incomplete fractures. 

The majority of fractures of the clavicle involve the middle third. The fracture pattern may be buckle, greenstick or displaced. Callus formation can be exuberant and, because it is subcutaneous, the prominence can be a cause of concern (Fig. 17.1). Treatment is usually symptomatic with a broad arm sling for comfort. A figure eight harness can provide additional support, especially for displaced... 

Rogers LF, Malave S Jr, White H, Tachdjian MO (1978) Plastic bowing, torus and greenstick supracondylar fractures of the humerus radiographic clues to obscure fractures of the elbow in children. Radiology 128 145-150 Roposch A, Reis M, Molina M, Davids J, Stanley E, Wilkins K, Chambers HG (2002) Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children a report of forty-seven cases. J Pediatr Orthop 21 307-312... 

Galeazzi fracture patterns occur where there is a fracture of the distal radius associated with disruption of the distal radioulnar joint, and are relatively rare in children. More common is the Galeazzi equivalent lesion, where the radial fracture occurs with a distal ulnar physeal fracture (Fig. 19.41). Multiple subtypes have been classified (Letts and Rowhani 1993), most of which can be treated with closed manipulation and cast fixation. If the radial fracture is complete rather than greenstick, internal fixation will be required. 

---