greenstick

Greenstick fracture is an incomplete fracture of a long bone that occurs most often in children. It happens when a bending force causes the bone to crack on the tensile (convex) side while the opposite cortex stays intact, so the bone bends rather than breaks completely. The term stems from the analogy to a green wood stick that bends without snapping.

Most common sites are the radius and ulna, followed by the tibia. It occurs most frequently in children between ages 5 and 10, when bones are more pliable and the periosteum is thick. A fall onto an outstretched hand is a common mechanism.

Clinical features include acute pain, swelling, and focal tenderness; deformity may be present or may be minimal. Radiographs show an irregular cortical contour with a fracture line that does not span the entire bone; the opposite cortex remains intact and there may be a periosteal hinge.

Management consists of immobilization in a well-fitted cast or splint. Displaced greenstick fractures may require closed reduction under anesthesia, followed by immobilization. Analgesia is provided as needed. Follow-up radiographs ensure alignment during healing. The typical healing period in children is several weeks (often 3–6 weeks for radius/ulna, longer for weight-bearing bones depending on age).

Prognosis is generally favorable, with most fractures healing well and remodeling capacity remaining high in children. Complications can include angulation, malunion, or growth disturbance, particularly if there is associated physeal injury or if the fracture is not adequately stabilized.