Greenstick Fractures

Introduction

Green stick fractures occurs in the children below 10 years of age. 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.

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).Vitamin D deficiency can also lead to greenstick fracture of long bones.

Epidemiology

Approximately 12% of all pediatric emergency department visits in the United States are due to musculoskeletal injuries. Fractures make up a large percentage of musculoskeletal injuries resulting in significant morbidity and complications. Greenstick fractures are most likely to be found in the pediatric population under 10 years of age but can occur in any age group, including adults.[3] There is equal incidence rate in female and male patients, however, male patients are more likely to sustain fractures

Pathophysiology

A greenstick fracture is a partial thickness fracture where only cortex and periosteum are interrupted on one side of the bone but remain uninterrupted on the other.[1] They occur most often in long bones, including the fibula, tibia, ulna, radius, humerus, and clavicle. Most commonly, they occur in the forearm and arm involving either the ulna, radius or humerus.[1][3] This is because people brace falls with an outstretched arm, resulting in fractures to the upper extremities.

Greenstick fractures can also occur in the face, chest, scapula and virtually every bone in the body, but with much less frequency than long bones.[3] For example, greenstick fractures can occur in the jaw and nose.[7] Condylar fractures are the most common pediatric mandibular fractures, accounting for up to 55% of all mandibular fractures.[8] There are 3 types of condylar fractures. Low subcondylar fractures are the most common and are incomplete greenstick fractures the majority of the time.[8] Nasal trauma most commonly leads to greenstick fractures in the pediatric population due to an unfused midline suture and majority cartilage make up of the nasal bones.[9]