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Greenstick Fracture – Bone Fracture in Children

A greenstick fracture is an incomplete bone fracture that occurs almost exclusively in children, where the bone bends and breaks on one side while the other side remains intact.

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Things worth knowing about "Greenstick fracture"

A greenstick fracture is an incomplete bone fracture that occurs almost exclusively in children, where the bone bends and breaks on one side while the other side remains intact.

What is a Greenstick Fracture?

A greenstick fracture is a unique type of bone fracture that occurs almost exclusively in children and adolescents. The name comes from the behavior of a fresh, flexible twig: when bent, it breaks on one side while the other side remains intact. Similarly, in a greenstick fracture, the bone does not break all the way through. Only the outer layer of the bone (the cortex) on the tension side cracks, while the compression side stays intact, resulting in an incomplete fracture.

Causes

Greenstick fractures are caused by bending forces applied to the still-soft and flexible bones of children. Common causes include:

Falls onto an outstretched hand or arm (most frequent cause)
Direct impact to the limb
Sports injuries, such as during cycling, climbing, or gymnastics
Everyday play accidents

Because children's bones contain more collagen and are less mineralized than adult bones, they are more flexible and prone to incomplete fractures rather than complete breaks.

Commonly Affected Bones

Greenstick fractures most commonly occur in the following bones:

Forearm: the radius and ulna (most frequent location)
Lower leg: tibia and fibula
Clavicle (collarbone)
Finger bones (phalanges)

Symptoms

Symptoms of a greenstick fracture can vary depending on severity. They are often less pronounced than those of a complete fracture, which can make diagnosis more challenging:

Pain at the affected site, especially when pressure is applied or the limb is moved
Swelling and possible bruising around the injury
Limited range of motion in the affected limb
Possible mild angulation (bending deformity) of the bone
No complete loss of stability, as the bone remains connected

Diagnosis

Diagnosis is typically confirmed through an X-ray. The X-ray image characteristically shows a one-sided cortical break while the opposite side of the bone remains intact. In some cases, additional imaging such as computed tomography (CT) or ultrasound may be used for a more detailed assessment of the fracture.

Treatment

Treatment depends on the degree of angulation and the bone involved:

Conservative Treatment

Most greenstick fractures are managed conservatively. The affected limb is immobilized in the correct position, usually using a cast or a splint. Immobilization typically lasts 3 to 6 weeks, depending on the child's age and the location of the fracture. Due to the high regenerative potential of children's bones, greenstick fractures generally heal completely without lasting complications.

Reduction

If significant angulation is present, the bone must be reduced (realigned) before immobilization. This is usually performed under mild sedation or brief general anesthesia.

Surgical Treatment

Surgery is rarely required for greenstick fractures. It is only considered in cases of severe malalignment or fractures in critical anatomical locations.

Healing and Prognosis

The prognosis for greenstick fractures is excellent. Children's bones have a remarkable capacity for remodeling, meaning that minor residual deformities can be corrected naturally as the child grows. In the vast majority of cases, full recovery without permanent impairment is expected.

References

Weinberg, A. M. & Tscherne, H. (Eds.) - Unfallchirurgie im Kindesalter. Springer Medizin Verlag, Berlin/Heidelberg (2006).
German Society for Pediatric Surgery (DGKCH) - Guidelines on Fractures in Children. AWMF Clinical Practice Guidelines.
Rockwood, C. A. et al. - Fractures in Children. Lippincott Williams & Wilkins, Philadelphia (2010).

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