Greenstick Fracture

What is a Greenstick Fracture?

A greenstick fracture is a type of bone fracture commonly seen in children, where the bone bends and partially breaks, similar to how a green twig snaps. It typically occurs due to a fall or direct trauma and is often seen in the arms. Treatment usually involves immobilization with a cast or splint to allow proper healing.

Green twigs bend without breaking, but eventually, they split or shatter where you bend them. Older branches separate easily. Greenstick fractures are similar to bending that young twig; they occur when a bone breaks along one side without breaking into several pieces. Since children’s bones are softer and less brittle than adults’, almost all greenstick fractures occur in youngsters under the age of ten.

If your kid has a greenstick fracture, they will most likely need to wear a cast while their bone heals. Surgery is necessary to fix more serious fractures, particularly if they are accompanied by additional injuries.

Causes of Greenstick Fracture

Although falls on an extended arm (FOOSH) are the most prevalent cause of greenstick fractures, other traumas such as car crashes, sports injuries, or non-accidental trauma involving a kid being struck by an item can also result in these injuries. Following a trauma, the incidence of greenstick fractures of the long bones is increased by malnutrition, particularly vitamin-D insufficiency.

Epidemiology of Greenstick Fracture

Injuries to the musculoskeletal system account for around 12% of all pediatric ED visits in the US. A considerable portion of musculoskeletal injuries that result in serious morbidity and consequences are fractures.

Although they can happen in any age group, including adults, greenstick fractures are most frequently observed in children under the age of ten. Although the incidence rate is the same for male and female patients, fractures are more common in male patients.

Pathophysiology of Greenstick Fracture

Only the cortex and periosteum are disrupted on one side of the bone, while the other side remains intact in a greenstick fracture, which is a partial thickness fracture. The fibula, tibia, ulna, radius, humerus, and clavicle are among the long bones where they most frequently occur. They most frequently affect the ulna, radius, or humerus in the forearm and arm. This occurs when people use their outstretched arms to support falls, which can lead to upper extremity fractures.

Although they happen considerably less frequently than long bones, greenstick fractures can also happen in the face, chest, scapula, and almost every other bone in the body. For instance, the jaw and nose may sustain greenstick fractures. Up to 55% of all juvenile mandibular fractures are condylar fractures, making them the most prevalent kind. Condylar fractures come in three different varieties.

The most frequent fractures are low subcondylar fractures, which are typically incomplete greenstick fractures. Because the nasal bones are primarily composed of cartilage and the midline suture is not fused, nasal trauma most frequently results in greenstick fractures in children.

Types of greenstick fractures

Usually, greenstick fractures affect longer bones,

• The humerus is the upper arm bone.
• The ulna and radius are forearm bones.
• Phalanges (bones of the fingers and toes).
• The Thigh bone, or femur.
• The calf bone, or fibula.

Symptoms of Greenstick Fracture

The following are the most typical symptoms of a greenstick fracture:

• Pain.
• Discoloration or bruises.
• Sensitivity 
• A portion of your child’s body seems more twisted or bent than normal.

Doctor examination of Greenstick Fracture

History and Physical Examination

Patients with greenstick fractures undergo the same physical examinations and history as patients with other kinds of fractures. Important aspects of the history include age, gender, anatomic location, soft tissue involvement (open versus closed), and the mechanism of injury. A physical examination’s location, soft tissue involvement, and neurovascular condition are crucial components. Additionally, it is important to check for multiple fractures or concealed fractures in the joints above and below the location.

Unintentional trauma, such as FOOSH, is frequently seen in history reports; however, other types of accidental trauma, such as being struck by a baseball bat or another object, may also be included. Non-accidental trauma, however, must always be taken into account. Depending on the patient’s age, they may scream uncontrollably, complain of discomfort in the wounded limb, refuse to move the injured extremity, or show protective behavior.

Reduced range of motion, palpable discomfort, and ecchymosis over the damaged region are typical physical symptoms. Edema, tenting if displaced, soft tissue abnormalities including abrasion or laceration, and indications of neurovascular bundle damage are more serious findings. Greenstick fractures can cause median nerve damage, which should be suspected while evaluating a distal forearm. Every severe injury should have a thorough neurological examination. Multiple injuries and ecchymoses in varying stages of healing that do not follow an age-appropriate damage pattern are additional observations that can point to non-accidental trauma.

Diagnostic evaluation

An x-ray of the damaged extremity or region of the complaint is part of the diagnostic examination. A bending injury with a fracture line that partially penetrates the bone is typical of X-ray results. On one side (the tension side), there is a fracture of the cortex and periosteum that does not spread to the opposite side. The opposing side of the bone shows plastic deformation from compressive pressures, whereas the tension side of the bone has a visible fracture on an x-ray.

Differential Diagnosis of Greenstick Fracture

• Salter-Harris fracture,
• torus fracture,
• spiral fracture,
• non-accidental fracture,
• open fracture,
• pathologic fracture,
• non-displaced fracture,
• plastic abnormalities,
• toddler fracture (non-displaced spiral fracture of the distal tibia), and more.

Management of Greenstick Fracture

Conservative Management of Greenstick Fracture

The medical professional must conduct a closed reduction and immobilization if the degree of angulation is substantial. Immobilization is necessary for all greenstick fractures, and casting a few days after the original injury reduces the chance of a requirement for a recast because of post-fracture swelling. Depending on the child’s age and degree of angulation, an orthopedic referral during the first visit is usually advised.

Long bone greenstick fractures should be immobilized with a cast for around six weeks. The location of the fracture determines the kind of cast to use. While proximal fractures require long arm castings and may be converted to short arm casts at around three weeks, distal fractures can be placed in short arm casts. Closer orthopedic follow-up is necessary for patients who have proximal fractures. However, because of their instability and higher risk of refracture and displacement in comparison to buckle or plastic bending injuries, all greenstick fractures should have some kind of orthopedic follow-up.

Splinting is a less usual treatment for greenstick fractures, although it can be used if there is little angulation and the patient or family is well monitored. Splinting may be less expensive, and it will be possible to take the splint off for showers.

Physical Therapy of Greenstick Fracture

Splinting can be used to cure it, but family members must be closely watched. It typically takes six weeks of immobility to correctly position the pieces.

The following methods may be used in physical therapy to treat greenstick fractures:

• Heat therapy and massage: it is used to reduce residual edema and relieve chronic pain.
• Joint Manipulation: To help the early scar tissue prevent the normal range of motion from breaking down, physiotherapists may gently move the joint.
• Exercise Program: To regain a complete range of motion and avoid problems from tissue injury need to stick to a customized exercise program created by the physiotherapist.

Complication of Greenstick Fracture

The following are the most frequent complications of greenstick fracture surgery:

• Malunion: This occurs when a fractured bone does not align appropriately throughout the healing process.
• Nonunion: A bone might not entirely or at all re-grow together.
• Acute compartment syndrome (ACS): Prolonged pressure in the muscles can prevent blood flow to the tissue, resulting in irreversible damage to the muscles and nerves.

Prognosis of Greenstick Fracture

The prognosis is generally favorable; most greenstick fractures restore successfully without causing noticeable or functional alterations to the affected bone. However, there is a chance of refracture, total fracture, and fracture displacement if the patient is not correctly immobilized and receives inadequate orthopedic follow-up.

FAQs

References

• Atanelov, Z., & Bentley, T. P. (2023, April 25). Greenstick fracture. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK513279/
• Greenstick fractures. (2025, January 31). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17812-greenstick-fractures