Greenstick fracture

Background

• Cortical disruption and periosteal tearing on convex side of bone only
• More stable / less painful than complete fracture

Clinical Features

• Pediatric fracture type

Radius and ulna greenstick fractures

Differential Diagnosis

• Torus fracture

Evaluation

• Ultrasound scanning seems to be as sensitive as plain x-rays and may be better at demonstrating the degree of cortical deformity

Management

• Need for reduction determined by angulation, location, and age of child
• As a general rule, manipulation may be considered for deformity obvious to the naked eye or if more than the following acceptable angles:
  • >10 years old then < 10 degrees is acceptable.
  • <10 years old then < 15 degrees is acceptable.

Traditionally these fractures have been treated by immobilisation in plaster for a period of around 3 to 6 weeks

• Fractures not requiring manipulation have a universally good outcome regardless of treatment
• Higher levels of patient satisfaction with a Futura type splint

Disposition

• Patients not requiring manipulation can be discharged with a backslab and advice to remove in 3 weeks or a Futura type splint and advice to remove when comfortable. There is no evidence that routine follow up is necessary.