The Greenstick Fracture

The greenstick fracture is one of the unique descriptions of children's fractures. To understand what it is, one must first know what a fracture is.

The greenstick fracture is one of the unique descriptions of children's fractures. To understand what it is, one must first know what a fracture is. Many people automatically think of broken bones, but a fracture is actually a soft tissue injury (soft tissues are muscles, etc.), made worse by the presence of a broken bone or bones. This is important because a doctor cannot treat a broken bone without bearing in mind that the structures surrounding it also need attention.

With a greenstick fracture therefore, it can be surmised that here, a bone has been broken. But the unique characteristic of this fracture is that it is hardly evident when seen on an x-ray plate. Outwardly, the area may look swollen, and be painful to move or to the touch, but when viewed on an x-ray plate, a doctor will not find it easy to see a sign of a broken bone. This is because the fracture is incomplete, which means it does not go through and through the bone. There is a break in the bone, but because the bones of children are more pliable than adult bones, the force that created the break only broke the outer part of the bend. Usually, in an adult, a corresponding amount of force would have broken the same bone completely. The name "greenstick" fracture comes from the analogy made between a child's bone and a young branch of a plant, as compared to the bone of an adult, represented by a plant's old branch. The former can bend farther to a certain degree than the latter, which might already have become hard and almost brittle.

Another thing with the greenstick fracture is that it will involve only one side of the bone. This would be better understood by imagining a hollow tube like a plastic pipe. Seen in lengthwise cross-section, the pipe would appear to have two walls. The long bones of the body are almost exactly like this, and these "walls" in bones are called cortices (singular: cortex). If a force were applied to bend the bone so that only one of these cortices breaks, and the break does not go through and through, the fracture produced is called a greenstick fracture. The bend is referred to as an "angulation." The "hump" from the angulation may be "dorsal," meaning, for example, in a case of a forearm greenstick fracture that is the most common type, it is seen at the back of the forearm. It may also be "volar," which means that the "hump" is at the side of the forearm that one sees when looking at the palm. Usually, in a greenstick fracture, there will not be just a bending force, but a rotating force as well, which means that not only did the bone curve a little, but it also twisted a little along the bone's axis.

When a doctor sees a child with a greenstick fracture, he or she will usually give anesthesia to the child, who will obviously be in pain. Then, with the anesthesia to make the child feel no pain, he or she will try to push the bone back into a non-curved position using his or her thumbs. Some doctors may complete the fracture, which means they will break the bone through and through. This is effective because there is a strong structure adhering to and covering the bone called the "periosteum," which does not break so easily, and will keep the broken sections in place. As long as these sections are kept strictly immobile in a plaster cast, the fracture will heal correctly. It is a plus that in children, fractures tend to heal more quickly than in adults. The cast will usually have to remain on for just 3 weeks, extending up to 6 weeks.

Reference: Pujalte, Jose M. and Jose S. Pujalte, Jr. E.R. Orthopedics, 2nd Ed. M.G. Reprographics, 7-1 Villamor Street, San Juan, Metro Manila. 1996.

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