Greenstick Fracture

Ovid: 5-Minute Sports Medicine Consult, The

Greenstick Fracture
Greg Canty
K. Brooke Pengel
Greenstick fractures are incomplete fractures that occur when a bone is exposed to bending forces. The bending forces are strong enough that the bone begins to fracture, but the force is not sufficient enough to result in a complete fracture:
  • The fracture appears on the tension (convex) side of the bone as a break in the periosteum and the cortex.
  • The compression side of the bone, or the concave surface, remains intact and appears as a hinge.
  • This fracture pattern is most commonly described in forearm fractures of growing children.
  • Greenstick fractures may be isolated or may coexist with other complete fractures in forearm injuries.
  • Most recent study states up to 5% of childhood and adolescent fractures are of the greenstick variety (1)
  • Previous studies have estimated even greater percentages of childhood fractures are of the greenstick variety.
  • Although extremely rare, there have actually been a few case reports of greenstick fractures in the young adult population (2)
  • Forearm (radius or ulna) = most common
  • Proximal humerus
  • Tibia
Greenstick fractures occur in children and adolescents because the bone is more:
  • Porous
  • Compliant
  • Resilient
  • Soft
Commonly Associated Conditions
  • Complete fracture of an accompanying bone (common)
  • Fracture/dislocation like a Monteggia variant (proximal 3rd ulna fracture with anterior disruption of radial head) (rare)
Pre Hospital
Suspect with any forearm injury having a mild angular deformity, swelling, and pain
  • Establish mechanism of injury, which is often a fall on outstretched hand with some rotational force.
  • Inquire about any numbness, tingling, or pain out of proportion to exam findings.
Physical Exam
  • Pain and localized tenderness to palpation
  • Unwillingness to use or mobilize the affected extremity
  • Mild to moderate angular deformity
  • Swelling
  • Ecchymosis
  • Palpation of bony deformities
  • Crepitus
  • Assess the distal portion of the affected extremity for:
    • Circulation (capillary refill and pulses)
    • Motor function
    • Sensation
  • Assess proximal and distal joints/bones for related injuries.
Diagnostic Tests & Interpretation
  • Anteroposterior and lateral radiographs required for diagnosis
  • Look for tearing of the periosteum and cortex on the convex side of affected bone.
  • Concave surface of affected bone should have intact periosteum.
  • Plastic deformation of bone may also be apparent.
  • Oblique views may occasionally be helpful.
  • Repeat radiographs after reduction.
Differential Diagnosis
  • Complete fracture
  • Compound fracture
  • Plastic deformation/Bowing deformity
  • Torus (buckle) fracture
  • Contusion
  • Sprain
Ongoing Care
Follow-Up Recommendations
Patient Monitoring
  • Repeat radiographs should be obtained at 1 and 2 wks to ensure alignment is being maintained.
  • Beware of the risk for greenstick fractures of the tibia to result in a valgus deformity (follow for 1–2 yrs)
  • Loss of reduction or progression of any deformity warrants surgical consideration, although younger patients have excellent capability of remodeling and rarely require surgery.
  • Greenstick fractures are expected to heal completely.
  • Complications are rare.
  • Remodeling capabilities are tremendous in young patients.
  • Excellent prognosis
  • 812.00 Fracture of unspecified part of upper end of humerus, closed
  • 813.81 Fracture of unspecified part of radius (alone), closed
  • 813.82 Fracture of unspecified part of ulna (alone), closed

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