Most doctors and medical professionals start out treating a greenstick fracture with a splint. Splints immobilize the impacted area but are generally thought to be a lower-impact intervention than a full cast. Greenstick-variety factures are somewhat unique in that the bone isn’t broken all the way through; one side usually cracks, but the other just bends. A splint can reorient the bone and unbend it such that it will heal on its own. When this doesn’t seem to be working or when the patient is unable to keep the splint still and stable, a plaster cast is usually the next option. In most cases medical experts will also prescribe medications for the pain associated with the fracture as needed. Regular monitoring is also usually part of any treatment plan.
Understanding These Fractures Generally
Greenstick fractures are also sometimes known as incomplete fractures or willow breaks, and they’re characterized by a bone crack that doesn’t actually break the entire bone. The “green” name is usually though to be a reference to green twigs or branches on trees; bending or twisting them will often crack the outer bark casing but will leave the green stick on the inside more or less unharmed. This sort of fracture is almost exclusively seen in children and young adults whose bones have not yet fully formed and hardened. The bones bend and break incompletely because they aren’t as brittle as older adult bones; they’re more resilient to trauma and tend to heal faster, too.
Most of these fractures fall into three categories: bow, transverse, and buckling or torus. The bow fracture is so named because the bone curves lengthwise, similar to the sort of bow used in archery or hunting. A transverse fracture starts in the cortex of the bone and extends lengthwise across the bone. It does not affect the other cortex. Impact injuries are the most common causes of the buckling or torus fracture, which generally causes the bone to bend into itself, forming a small bump or buckle.
Doctors usually start with the least invasive method of treatment. Patients are usually first given a mild pain killer or local anesthetic to calm pain and reduce inflammation at the site of the injury. Young children who are unable to remain calm for an exam may also be given a mild sedative. X-rays are almost always performed to assess the extent of the injury and to confirm the initial diagnosis.
Most of the time, a splint is all that is required, though this does depend at least in part on the severity of the break. If a splint can provide adequate support, then many doctors will choose that method. A major benefit of a splint over a cast is that it can be temporarily removed for bathing; it is also a lot less invasive and provides more opportunities for adjustment and monitoring.
In some situations a greenstick fracture can also be treated with both a cast and a splint. In a typical situation, a doctor may choose to first treat the fracture with a splint, but switch to a cast if X-rays show that the bone is not healing properly. The opposite may also occur, where the bone heals quickly enough that it is possible to change to a smaller cast or splint.
Symptoms of greenstick fractures can be difficult to recognize, and in some cases they may not appear at all. Pain is almost always present, but, especially in very young children, it can be difficult to differentiate a bump and bruise or even general fussiness from a true problem. More visible symptoms can include a limb that is twisted or bent in an abnormal way and pain or swelling in the affected area. The visible appearance of the injury and the associated pain will typically not be as intense as with a total break. In general, it’s a good idea to get a medical evaluation any time a limb has a reduced range of motion or cannot bear weight, particularly after a fall or a known trauma.
Importance of Regular Monitoring
Treatment typically also involves a regimen of regular monitoring. Doctors usually want to keep a close eye on how these sorts of fractures are healing, and will usually intervene if they see anything unusual or uncommon in how the bones are setting back into place. Problems in greenstick healing sometimes indicate larger bone or blood problems, many of which have better prognoses the sooner they’re discovered. Children who experience frequent or recurring fractures are usually also monitored for nutrient levels and, depending on the circumstances, abuse.