A single copy of this article may be reprinted for personal, noncommercial use only.
Greenstick fracturesBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/greenstick-fractures/DS00817
CLICK TO ENLARGE
A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. This type of broken bone most commonly occurs in children because their bones are softer and more flexible than are the bones of adults.
In some cases, a greenstick fracture can be difficult to diagnose because there may not be much pain or swelling and the child is using the limb and has full motion. Mild greenstick fractures sometimes are thought to be sprains.
Even mild greenstick fractures are usually immobilized in a cast. In addition to holding the cracked pieces of the bone together so they can heal, a cast can help prevent the bone from breaking all the way through if the child falls on it again.
The intense pain, swelling and obvious deformity typical of broken bones may be absent or minimal in mild greenstick fractures. Other greenstick fractures may be easily diagnosed because the arm or leg is deformed and there is significant swelling.
When to see a doctor
Contact your doctor if your child has persistent pain in an injured limb. Seek immediate medical attention if a child is unable to bear weight or if there is obvious pain, deformity and swelling.
Childhood fractures most commonly occur with a fall. Arm fractures are more common than leg fractures, since the usual reaction is to throw out your arms when you start to fall.
Preparing for your appointment
If your child has significant pain or an obvious deformity, you might go straight to an emergency room or urgent care clinic. The doctor who first examines your child may recommend a consultation with a pediatric orthopedic surgeon.
What you can do
To prepare for your conversation with the doctor, you may want to write a quick list that includes:
- Your child's symptoms
- How the injury occurred
- Your child's key medical information, including any previous fractures, other medical problems, allergies, and the names of all medications and vitamins he or she takes
- Any other questions you want to ask the doctor
Remember to bring a copy of any X-ray images (usually on a disk) and medical notes if your child has already been seen at an urgent care clinic or another medical center.
What to expect from your doctor
Your doctor may ask:
- Was there a clear injury associated with the beginning of symptoms?
- Has the child been able to walk or bear weight on the limb?
- Where exactly does it hurt?
- Has the child otherwise been feeling well — any fevers, fatigue, illness?
Tests and diagnosis
During the physical exam, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. The child will be asked to gently move that limb's fingers or toes.
X-rays can reveal most greenstick fractures. Some greenstick fractures are difficult to see because a small bend in the bone may not show up as well on X-rays.
Treatments and drugs
Most fractures of the arms and legs require a cast to keep the bones in good alignment while the break heals. If the bones are in a poor alignment, they may need to be repositioned, typically under sedation.
On occasion, your doctor may decide that a removable splint could work just as well, particularly if the break is mostly healed. The benefit of a splint is that your child might be able to take it off briefly for a bath or shower.
X-rays are required in a few weeks to make sure the fracture is healing properly, to check the alignment of the bone, and to determine when a cast is no longer needed. Most fractures or breaks require four to eight weeks for complete healing, depending on the break and the age of the child.
After the cast is removed, the child should avoid high-impact activities for another one to two weeks to keep from re-injuring the arm or leg. Your child will quickly rebuild muscle and function in the limb with normal daily activities. Physical therapy usually isn't required.
Here are some tips to reduce your child's risk of greenstick fractures:
- Encourage regular exercise, which builds strong bones.
- Ensure that your child always wears safety gear for sports.
- Use car seats and seat belts at every age.
- Provide adequate calcium in your child's diet. Check with your doctor to see how much calcium your child needs, because the amount varies with age.
- Green NE, et al. Skeletal trauma in children. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4160-4900-5..X1000-X--TOP&isbn=978-1-4160-4900-5&uniqId=406908857-2. Accessed April 2, 2013.
- Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-05472-0..X0001-1--TOP&isbn=978-0-323-05472-0&uniqId=230100505-57. Accessed April 2, 2013.
- Larson NA (expert opinion). Mayo Clinic, Rochester, Minn. April 11, 2013.
- Fractures. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/injuries_poisoning/fractures_dislocations_and_sprains/fractures.html?qt=greenstick&alt=sh. Accessed April 2, 2013.
- Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 21st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=14. Accessed April 2, 2013.
- Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=40. Accessed April 2, 2013.
- Wang J, et al. Diagnosis and assessment of distal forearm fractures in children. http://www.uptodate.com/home. Accessed April 2, 2013.
- Forearm fractures in children. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00039. Accessed April 2, 2013.
- Schweich P. Closed reduction and casting of distal forearm fractures in children. http://www.uptodate.com/home. Accessed April 2, 2013.