A study of greenstick fractures in forearm bones in children

Abstract

Background and objectives: Definition: A fracture in which one side of a bone is broken and the other is bent John Insall, a British-American orthopedist and Michal Slupecki, a Polish-American orthopedist, described the fracture like that of a breakage of green wood, which simply breaks outer side when bent. Ligaments and Tendons are stronger than bone when young. Bone is more likely to be injured than soft tissue. Periosteal is biologically active in children and often stays intact with injury. This stabilizes fractures and promotes healing. Force to side of bone may cause break in only one cortex–Greenstick fracture. The outer cortex only bends. In very young children none of the cortex may break–Plastic deformation. Methods: Out of 35 cases treated in our instate 23 were male and 12 female child. Patients pre and post reduction serial follow up x-rays were studied. Follow up period ranges from 3 months to 3 year. In greenstick fracture reduction done according to angulation of fracture. When the apex of the fracture is towards dorsum of the forearm (apex dorsal- pronation injury), the forearm supinated to achieve reduction. When the apex of the fracture is towards volar aspect of the forearm (apex volar- supination injury), the forearm pronated to achieve reduction. Results: Out of twenty patients treated, overall good to excellent results were obtained in 96% patients. The results was fair in one patient each. There were no intraoperative complications. Interpretation and conclusion: Maximum fractures were in age group of 5-10 year with predominance in males. Most of the fractures were on subordinate side. Average union time in greenstick fracture was 6 week. In this series the highest degree of angulation (at final follow up) which got corrected was in radius 18° and in ulna 13°. Remodeling and returning of final range of motion is excellent.