Greenstick fracture

A greenstick, buckle or torus fracture is a fracture in a young, soft bone in which the bone bends and partially breaks. A person's bones become harder (calcified) and more brittle with age. Greenstick fractures usually occur most often during infancy and childhood when one's bones are soft. The name is by analogy with green wood which similarly breaks on the outside when bent. It was discovered by British-American orthopedist, John Insall and Polish-American orthopedist Michael Slupecki.

There are three basic forms of greenstick fracture. In the first a transverse fracture occurs in the cortex, extends into the midportion of the bone and becomes oriented along the longitudinal axis of the bone without disrupting the opposite cortex. The second form is a torus or buckling fracture, caused by impaction. The third is a bow fracture in which the bone becomes curved along its longitudinal axis.

Signs and symptoms
Some clinical features of a greenstick fracture are similar to those of a standard long bone fracture- greenstick fractures normally cause pain at the injured area. As these fractures are specifically a pediatric problem, an older child will be protective of the fractured part and babies may cry inconsolably. As per a standard fracture, the area may be swollen and either red or bruised. Greenstick fractures are stable fractures as a part of the bone remains intact and unbroken so this type of fracture normally causes a bend to the injured part, rather than a distinct deformity, which is problematic.

Pathogenesis and risk factors
The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a green stick fracture. The fracture usually occurs in children and teens because their bones are flexible, unlike adults whose brittle bones usually break. It is also common in older adults.

Greenstick fractures should not be confused with buckle fractures (or torus fractures) which are an impaction type of fracture identified by a focal widening (or outward buckling) of the cortex.

Treatment
Removable splints results in better outcomes to casting in children with torus fractures of the distal radius. Traditionally buckle fractures have been casted either below or above the elbow.