Bent, but Not Broken: Greenstick Bone Fractures in Kids + What to Do
Children under age 10 are more at risk for greenstick fractures. Find out when you should suspect your child has this injury and what to do.
Your child is running across the playground, when suddenly, she trips — instinctively flinging out her arm to break her fall. As she moves to stand, she clutches her forearm, wincing in pain. Something isn’t right. You take her to the hospital emergency department right away, wondering if it’s a broken bone.
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X-rays confirm that it’s a greenstick fracture — an injury where one side of the bone bends and cracks, but doesn’t break completely.
“It’s named after the way a flexible young tree branch or twig tends to resist fully breaking when you bend it,” says pediatric orthopaedic surgeon Thomas Kuivila, MD. “It doesn’t snap into two parts. One side breaks and splinters up a little bit while the other side compresses together.”
This is good news as opposed to a fully broken bone because these injuries tend to heal quickly and completely in young children.
Greenstick fractures are incomplete fractures that occur in growing bones, most often in the long bones of the arms or legs.
They’re often caused by a fall, and they tend to occur in children younger than age 10. Their bones are still growing, and, as a result, are softer and less brittle than an adult’s.
“When you exert a bending force on the bone, sometimes it snaps and sometimes it just partially fails,” Dr. Kuivila says. “What you are left with is a bone that is usually angulated but still in continuity. So it’s almost as though the bone has bent.”
Symptoms vary depending on the severity of the fracture. They may include:
Any time your child has a significant fall and you notice a deformity — the arm isn’t straight, for example — let a doctor evaluate him or her in the emergency department, Dr. Kuivila says.
“If they fall and are not in any pain, but their wrist is sore, it doesn’t mean you have to jump in the car right away,” he says. “You can put ice on it and if it’s still sore a couple hours later, then you may want to seek medical advice.”
Ice the affected area immediately, no matter what.
“Ice in and of itself has local anesthetic qualities so it relieves the pain and swelling,” he says. “Icing also narrows the blood vessels to the area and prevents bleeding. Ice is always a good thing.”
There are several ways an orthopedic surgeon may treat a greenstick fracture.
First, they’ll likely need to get a closer look at the injury with imaging. The doctor likely will order X-rays of the fracture. An MRI scan may help rule out other injuries.
Next, in all likelihood, the bone will need to be put back into place. “The bone may need to be realigned or manipulated — it has to be pushed back into position,” Dr. Kuivila says. “This manipulation will require sedation for the child with an IV, either in the emergency department or in an operating room if the deformity is significant.”
In some cases, an orthopedic surgeon can bend the bone back to its original alignment, he says. Other times, to align the bone properly, he or she will need to bend the unbroken part of the bone until it fractures completely. Then, the surgeon will immobilize the fracture in a cast for about six weeks.
“A greenstick fracture is easily managed and heals promptly and reliably,” Dr. Kuivila says. “As with most fractures in growing bones, the fracture completely remodels itself so that within a year you don’t even see evidence of it in an X-ray.”