What Is Greenstick Fracture? 

Overview

A greenstick fracture presents as a crack that does not go all the way through a bone instead of a complete fracture. It is mostly seen in children below 10 years of age. These fractures are termed ‘greenstick’ due to their resemblance to the incomplete breaks that occur in the green branches of trees. Children experience rapid periods of growth. Hence, their bones are soft compared to mature adult bones, resulting in a bend at the site of injury. 

Greenstick fractures are mostly caused by falls onto an outstretched hand (FOOSH), vehicle collisions, or injuries sustained during physical activities. As a child's bones are still developing, they need nutrients and vitamins for healthy growth. Calcium is essential for bone health, and vitamin D is required to absorb calcium in the body. So, an inadequate amount of either can heighten the risk that a child will sustain a greenstick fracture after mild injury.¹ 

Types of fractures

A person can suffer a bone fracture during an injury or accident. Fractures can be complete or incomplete. There are different types of fractures:² 

• Open fracture: Also called a compound fracture, refers to an incidence where the broken bone comes through the skin and is visible to the naked eye
• Closed fracture: This a simple fracture where the bone breaks but does not penetrate the skin
• Transverse fracture: This fracture occurs when the bone breaks along a straight line. This fracture tends to affect the long bones and is usually seen in individuals who have suffered a fall or a sports injury.
• Greenstick fracture: A slight twist or bend is observed on the broken bone. This fracture is mostly seen in children who have soft bones compared with adults
• Spiral fracture:  In this type of fracture, the bone is broken by a circular, twisting motion. It is mostly seen in long bones, such as in the femur, the tibia, the fibula, the radius, or the ulna.
• Oblique fracture: A diagonal break on the bone. It also commonly affects long bones
• Compression: Such injuries cause the bone to be crushed and appear flat
• Comminuted fracture: This type of fracture is characterised by three or more breaks in one bone, typically causing the bone to separate into many pieces. They occur as a result of severe trauma, like car accidents or falls from higher places. Most of the time, individuals who have comminuted fractures require surgery
• Segmental fracture: A segmental fracture occurs when the bone is broken in two or more places, causing complete segmentation of the bone. It happens in cases of severe trauma and affected patients often require surgery.
• Displaced fractures: After a fracture has occurred, parts of the broken bone can move around and become misaligned

Sometimes fractures are classified according to their cause: 

• Stress fracture: A stress fracture, also called a hairline fracture,  is a small hairline crack in the bone. It is mostly seen in the tibia or the fibula as well as in the bones of the heels or feet. Around 20% of sports injuries are stress fractures.
• Avulsion fracture: Avulsion fractures can happen during sports activities when a ligament or tissue gets pulled away from the main bone. It can occur in the bones of the elbow, the knee, the spine, the wrist, the pelvis or the hip.
• Buckle fracture: A buckle fracture is an incomplete fracture that mostly affects children. It can happen when the bone is misplaced following a fall.

Causes of greenstick fracture 

Greenstick fractures are common in children. Arm fractures are more likely to occur compared to leg fractures. Two bones make up the forearm: the radius and the ulna. The lateral bone, which is on the same side as the thumb, is the radius, whereas the bone that is on the side of the little finger is the ulna. Distal radius fractures occur at the end of the radius, near the wrist bone. These are some of the most common types of fractures. Proximal radius fractures are instead found at the head of the radius, near the elbow.

Greenstick fractures can be sustained due to various causes. They can occur as a result of:³

• Injuries suffered during vehicle collisions 
• Injuries suffered during sports or any physical activities 
• Calcium deficiency
• Vitamin D deficiency

Signs and symptoms of a greenstick fracture 

If your child has recently suffered an injury, it is best to consult your GP so that your child can be examined for any signs of fractures. Symptoms of greenstick fracture vary depending on the severity. Mild fractures might be misdiagnosed as sprains. Some of the symptoms of greenstick fracture are:¹

• Pain at the site of injury
• Swelling 
• Tenderness 
• Bend at the site of injury

Diagnosis 

If your child is showing signs of a greenstick fracture or if they are in severe pain following an injury, contact your GP or make your way to the A&E department. For a diagnosis to be established, your doctor will conduct diagnostic imaging tests and perform a physical examination. This involves a:⁴ 

• Physical exam: A doctor will observe the patient for signs of pain, swelling or tenderness at the site of injury
• X-ray: An X-ray scan is a radiological procedure that produces images of the bones and can help to pinpoint any injury or fractures 
• CT scan: A CT scan is another radiological imaging test that helps diagnose fractures 

Management and treatment for a greenstick fracture

Once your doctor has diagnosed your child with a greenstick fracture, they will offer different treatment options based on the severity of the injury.¹

• Plaster cast: A cast or splint is applied to the injured limb to reduce its mobility, facilitating the healing process. The cast is put on for around four to six weeks. Distal fractures require a short cast, whereas proximal fractures require a long cast. Sometimes, a removable splint is applied, which can be removed while bathing. 
• Pain medication: Doctors can prescribe painkillers, such as ibuprofen, to relieve the pain that typically accompanies fractures
• Metal rod: If the injury is severe, orthopaedic specialists may insert a metal rod with screws at the site of injury. This rod helps to keep the bone in a straight position. The insertion may be temporary or permanent, depending on the injury.

Complications 

Greenstick fractures are considered to be the least severe out of all fractures. However, there are some complications associated with this type of fracture. If proper treatment is not provided, the fractured bone may become permanently deformed. Other complications include:

• Malunion or bone deformity 
• Bleeding 
• Infection 
• Nerve injury 
• High risk of subsequent fractures

FAQs

How can I prevent greenstick fracture? 

In order to prevent greenstick fractures, you must ensure that your child wears the proper protective equipment during sports activities and that they remain cautious at all times.

How common is a greenstick fracture? 

Greenstick fractures are relatively common in children under the age of ten.¹

Who is at risk of greenstick fracture? 

Children under the age of ten are at risk of sustaining a greenstick fracture. Malnutrition, which results in vitamin D and calcium deficiencies, can increase the risk of fractures. Additionally, it has been suggested that children who are overweight are likely to experience falls with greater force, causing them to have a heightened risk of sustaining greenstick fractures than children who are of average weight.⁵

When should I see a doctor? 

Contact your GP if your child has suffered an injury and is experiencing pain, swelling and tenderness at the injury site.

Summary 

A fracture is a term used to describe a break in the bone. Fractures can occur as a result of various injuries, which span from mild (falls) to severe (vehicle collisions).  Greenstick fractures are incomplete fractures that are mostly seen in children below the age of ten. To prevent the occurrence of greenstick fractures, it is important to ensure that your child receives a balanced and healthy diet that includes calcium and vitamin D.

If your child has sustained any injury and is in pain, you should contact your GP. Doctors can perform a physical exam and refer your child to receive an X-ray or a CT scan to confirm the diagnosis. If a greenstick fracture is confirmed, orthopaedic specialists will cast or remove the splint on the affected limb. Casts are typically worn for a duration of four to six weeks. In cases of severe injury, a metal rod can be put into the broken bone. If adequate and timely treatment is not provided, complications, such as limb deformities, bleeding, infections and nerve injuries, can occur. It is therefore important to ensure the safety of your child by teaching them to be cautious, providing them with protective equipment during sports activities and confirming that they are wearing seatbelts (or are sitting in appropriate car seats) when travelling in a vehicle.