Greenstick Fractures in Children

A greenstick fracture is one that occurs in a young, soft bone. Soft bones, such as those in a child’s forearm or wrist, can bend and break. The phrase comes from the analogy of a fresh, green piece of wood that will bend outward instead of breaking cleanly. Greenstick fractures occur most commonly in the forearms and wrists of children, often in falls. A child may place his or her outstretched hand out to break the fall, leading to a fracture in the arm or wrist.

Definition of a Greenstick Fracture

About 20% of children with injuries have fractures upon medical evaluation. Pediatric fractures occur most commonly in falls, but can also occur as the result of a car or bus accident, sports injury, or birth injury. Any compressive force that causes the young bone to bow instead of break can cause a greenstick fracture. When only one cortex breaks in the shaft of an immature bone, a greenstick fracture has occurred.

In a greenstick fracture, the bone bends and cracks instead of breaking into separate pieces like a normal fracture. A portion of the bone breaks, causing the other side of the bone to bend and flex. A greenstick fracture is an incomplete fracture, where a severe bending force applies to the immature bone without causing a complete break. Greenstick fractures are most common in children younger than 10 years old. The bone must be soft and flexible to result in a greenstick fracture, unlike adult bones that are hard, and that will break into multiple pieces in a fracture.

Symptoms of a greenstick fracture include persistent pain in the affected limb, the inability to bear weight on the limb, and obvious signs such as swelling or physical deformity. If you notice any of these symptoms, take your child to see a doctor or the emergency room. The doctor will conduct a physical exam and check for swelling, deformity, tender spots, numbness, or an open wound. An x-ray will reveal a greenstick fracture, at which point the doctor will recommend the appropriate treatment depending on the severity of the injury.

Treatment for Greenstick Fractures

Greenstick fractures can be painful, but are typically not causes for alarm. If the bones are not displaced, a short arm cast can be enough to set the injury and allow it to properly heal. A long arm cast may be necessary if displaced at greater than 15 degrees of angulation. The orthopedic doctor will need to place the elbow in 90 degrees of flexion to facilitate healing. To assess how the injury is healing, a doctor may prescribe weekly radiographs to check the location of the bones. Even mild greenstick fractures require a cast to immobilize the area of injury and allow the bone to mend in a proper position. A cast will hold the cracked bone fragments together as well as prevent the bone from suffering a complete break should the child fall on the same limb again. A complete break is a high possibility in greenstick fractures.

Before applying the cast, the doctor may need to manually straighten the bone. If this is necessary, your child will first receive pain medication or sedation drugs to make this procedure bearable.

For a minor fracture, or once the fracture has begun to heal, the doctor may prescribe a removable splint instead of a cast. It takes an average of four to eight weeks for a greenstick fracture to completely heal, depending on the child’s age and the severity of the damage. Closed treatment is appropriate for the majority of pediatric fractures, meaning no need for surgery. Indications that the fracture may require surgery include open fractures, residual deformity, and re-fracture. Children will generally not suffer any permanent damage from greenstick fractures.