Greenstick Fractures: Difference between revisions

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Pain on palpation, reduced range of motion and ecchymosis over injured part , edema, abrasion , laceration are the findings of physical examination.<ref name=":0" />
Pain on palpation, reduced range of motion and ecchymosis over injured part , edema, abrasion , laceration are the findings of physical examination.<ref name=":0" />


== Treatment ==
== Physiotherapy Treatment ==
It can be treated by splinting but close monitoring of the family members is required. The duration of immobilization required to align the fragments properly is  usually of 6 weeks.  
It can be treated by splinting but close monitoring of the family members is required. The duration of immobilization required to align the fragments properly is  usually of 6 weeks.  
 
Physiotherapy management will be the same as other fractures.
 
== Case Summary of Green Stick Fracture Of An Adult ==
A 23 year old male who was not having any past medical history suffered from a green stick fracture of the shaft of ulna, after the rehabilitation of left side ulna and radius fracture post internal fixation. The patient completed the physiotherapy rehabilitation after the surgery of internal fixation. After 9 months he was readmitted for the surgery of implant removal.<ref name=":1" />Bony union was seen on X-ray at the time of readmission over the fracture site. The patient under went rehabilitation till the discharge and after it he continued the physiotherapy treatment as an outpatient. After five months , he noticed tenderness on his operated elbow and heard a breaking sound during his physical therapy treatment. He was immediately sent to the emergency department and the X-ray showed green stick fracture of ulnar shaft. Cross elbow splint application for two months. The tenderness and numbness around the elbow was alleviated. Subsequent X-ray showed increased density and callus formation.
 
This study stated two mechanisms for the development of a green stick fracture. First is that the cortex of long bone may be weakened by drill holes from surgery. Drilled bone sustains low amount of energy before failing. The second reason is the force produced during joint mobilisation may have resulted in a fracture. 
 
Splinting appears to be a feasible option during green stick fractures. During treatment the physiotherapists should take care to avoid the occurrence of a green stick fracture. 


== References ==
== References ==

Revision as of 08:29, 3 October 2022

Introduction[edit | edit source]

Green stick fractures occurs in the children below 10 years of age. [1]. The incidence of it is 1 in 100 and the most commonly affected age group is between 5 to 14 years. It rarely occurs in adults.[2]There is partial thickness fracture where only cortex and periosteum gets affected on one side of the bone and it remains uninterrupted on the other side of the bone.[1]Usually happens in long bones such as radius, ulna, femur, tibia, humerus. Green stick fractures are unstable and they continue to displace after first 2 weeks.[3]

Etiology[edit | edit source]

Mechanism of injury is fall on the outstretched hand(FOOSH). It can also occur because of trauma such as road traffic accident, sports injuries or even a non accidental trauma (child hitting an object).[1]Vitamin D deficiency can also lead to greenstick fracture.[1]

Epidemiology[edit | edit source]

Fractures are the most common musculoskeletal injuries. It is most found in children below 10 years of age. It is less commonly seen in adults. The incidence rate among male and female is the the same.[1]

Pathophysiology[edit | edit source]

Green stick fractures occur in arm and forearm which involves ulna, radius or humerus. Less commonly it occurs on face , chest and scapula. The diaphysis and metaphysis are calcified in adult population and its weak in children leading to greenstick ,torus and plastic bending injuries. Greenstick fractures occurs anywhere in diaphysis and metaphysis but if the fracture is at the level of physis, it is no longer a green stick fracture.[1]

History and Physical Examination[edit | edit source]

It is similar to any other fracture. Age, location, involvement of the soft tissue , gender and mechanism of injury, neurovascular status are important features of history and examination.

Pain on palpation, reduced range of motion and ecchymosis over injured part , edema, abrasion , laceration are the findings of physical examination.[1]

Physiotherapy Treatment[edit | edit source]

It can be treated by splinting but close monitoring of the family members is required. The duration of immobilization required to align the fragments properly is usually of 6 weeks.

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Atanelov Z, Bentley TP. Greenstick fracture.
  2. Lin YC, Wang WT. Greenstick fracture of the ulnar shaft following physical therapy in an adult: A case report. Medicine. 2020 Dec 11;99(50).
  3. Randsborg PH, Sivertsen EA. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta orthopaedica. 2009 Oct 1;80(5):585-9.