Greenstick Fractures: Difference between revisions

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The makeup, anatomy, and histology of the pediatric skeletal system is not just a smaller version of the adult form; rather, it is unique in that it allows for rapid growth and change throughout development from childhood to adulthood
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== Introduction ==
Green stick fractures occurs in the children below 10 years of age. <ref name=":0" />. 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.<ref name=":1">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).</ref>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.<ref name=":0">Atanelov Z, Bentley TP. Greenstick fracture.</ref>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.<ref>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.</ref> 
 
== Etiology  ==
'''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).<ref name=":0" />Vitamin D deficiency can also lead to greenstick fracture.<ref name=":0" />
 
== Epidemiology ==
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.<ref name=":0" />The overall incidence of pediatric distal forearm fractures, including greenstick fractures, is approximately 738.1/100,000 persons/year.<ref>Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, Rahbek O, Elsoe R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233428/ Children’s distal forearm fractures: a population-based epidemiology] study of 4,316 fractures. Bone & joint open. 2022 Jun 6;3(6):448-54.</ref>
 
== Pathophysiology ==
Green stick [[Fracture|fractures]] occur in arm and forearm which involves ulna, radius or humerus. Greenstick fractures may manifest in various anatomical regions, including the face, chest, scapula, and virtually all bones throughout the body. However, their occurrence in these locations is notably less frequent compared to their prevalence in long bones.<ref>Atanelov Z, Bentley TP. [https://www.ncbi.nlm.nih.gov/books/NBK513279/ Greenstick fracture.]</ref> 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.<ref name=":0" />
 
== History and Physical Examination  ==
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.<ref name=":0" />
 
== 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.   
 
==== Physiotherapy Techniques ====
Physiotherapy treatment for greenstick fractures may include the following techniques<ref>Greenstick Fracture: Diagnosis and Prognosis - How Physiotherapy Returns Strength & Mobility; 2015 Dec 3.[https://www.physioinqstclair.com.au/blog/greenstick-fracture-diagnosis-and-prognosis-how-physiotherapy-returns-strength-mobility Available from:]</ref>:
 
* Massage and Heat Therapy: Employed for the purpose of alleviating persistent discomfort and diminishing residual swelling.
* Joint Manipulation: Physiotherapists may delicately manipulate the joint to facilitate the breakdown of initial scar tissue impeding normal range of motion.
* Exercise Program: Following a tailored exercise program designed by the physiotherapist is crucial for regaining full movement and preventing complications caused by tissue damage.
 
== References ==
<references />
[[Category:Fractures]]
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Paediatrics]]
[[Category:Paediatrics - Conditions]]
[[Category:Rehabilitation Interventions]]

Latest revision as of 09:52, 20 November 2023

Original Editor - Nupur Smit Shah

Top Contributors - Nupur Smit Shah, Esraa Mohamed Abdullzaher, Olaniyan Victor, Kim Jackson, Wanda van Niekerk and Lucinda hampton  

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]The overall incidence of pediatric distal forearm fractures, including greenstick fractures, is approximately 738.1/100,000 persons/year.[4]

Pathophysiology[edit | edit source]

Green stick fractures occur in arm and forearm which involves ulna, radius or humerus. Greenstick fractures may manifest in various anatomical regions, including the face, chest, scapula, and virtually all bones throughout the body. However, their occurrence in these locations is notably less frequent compared to their prevalence in long bones.[5] 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.

Physiotherapy Techniques[edit | edit source]

Physiotherapy treatment for greenstick fractures may include the following techniques[6]:

  • Massage and Heat Therapy: Employed for the purpose of alleviating persistent discomfort and diminishing residual swelling.
  • Joint Manipulation: Physiotherapists may delicately manipulate the joint to facilitate the breakdown of initial scar tissue impeding normal range of motion.
  • Exercise Program: Following a tailored exercise program designed by the physiotherapist is crucial for regaining full movement and preventing complications caused by tissue damage.

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.
  4. ↑ Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, Rahbek O, Elsoe R. Children’s distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone & joint open. 2022 Jun 6;3(6):448-54.
  5. ↑ Atanelov Z, Bentley TP. Greenstick fracture.
  6. ↑ Greenstick Fracture: Diagnosis and Prognosis - How Physiotherapy Returns Strength & Mobility; 2015 Dec 3.Available from:
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