The greenwood fracture

What is a greenwood fracture?

A greenwood fracture is a type of bone fracture that only occurs in children. Since children's bones have a different structure than adult bones, they often show a different fracture pattern.
A child's bones are still very flexible and have a much thicker periosteum. It can therefore be compared with the structure of young woods (green wood), hence the name green wood fracture.

In the event of a bone fracture, the bone breaks only partially, but not completely, similar to a young branch.

The reasons

The causes of greenwood fractures are very diverse.

A fall on the outstretched arm can be enough to break the bone. A sudden jerky twisting of the arms or legs, as can occur when playing or romping around, can often be the cause of the break. Greenwood fractures in children are also not uncommon in accidents in sports or in traffic accidents.

The reason for the incomplete fracture of the bone is, as already mentioned, the special structure of the child's bone. While the outside of the bones hardly differs from adult bones, the internal structure is the decisive point. The bones of adults are brittle and often break through completely when force is applied.
In contrast, children's bones react differently to heavy loads. They can compensate for part of the force due to their extraordinary elasticity and flexibility and therefore break only incompletely. Only the stretched side of the bone breaks, the compressed side remains intact.

Find out more about the topic here: childlike bone fracture.

Where does a greenwood fracture occur?

Greenwood fractures occur primarily on the long bones of children and adolescents, as they are still growing. In addition to the upper arm and thigh bones, these bones also include the bones of the forearms (ulna and radius) and lower legs (shin and fibula).

The ulna and radius are particularly often affected: up to a quarter of all forearm bone fractures in children are greenwood fractures.

Also read: Forearm fracture in the child.

The diagnosis

There are several ways to diagnose a greenwood fracture.

In the first step, a detailed discussion should be held about the course of the accident and the injury pattern, as this can often already be decisive.

In older children and adolescents, an X-ray should then be made to detect a fracture gap or even a malposition of the bone.
However, this method is often not suitable for younger children, as their bone substance is not yet sufficiently developed to be able to display it using X-rays.
In such a case, an ultrasound examination can be used. This also provides information about the position of the bones in relation to one another and can sometimes also detect injuries and hematomas (bleeding) in the surrounding soft tissue.

Read more on this topic: X-ray examination of the child

Concomitant symptoms

The main symptoms of a greenwood fracture include pain.

However, due to the bone structure of children, these can be easier than other bone fractures. The pain can occur around the fracture site and is particularly triggered by pressure over the fracture gap. In the event of suspicion, the doctor can also check this during the physical examination.

Any swelling that may occur can also cause pain and sometimes result in a painfully restricted range of motion. Especially if the fracture is close to the joint, swelling can impair the mobility of the joint. A hematoma (Latin for bleeding) can also occur over the fracture gap and in the entire region of the fracture. In addition, the child can feel pain when the affected part of the body is stressed. Especially when the bones of the legs are affected, it is often no longer possible to walk without pain.

Some children develop a mild fever with a greenwood fracture. This symptom is more common in children as part of a broken bone. It can also be checked by the doctor and give an indication of the fracture.

In rare cases, there is a visible misalignment of the affected limb. However, since greenwood fractures are only incomplete fractures, such an appearance is very rarely observed.

Can a greenwood fracture proceed without pain?

Due to the special nature of children's bones, the pain that occurs in the case of a greenwood fracture may also be less severe. However, it is unlikely that a child who does not feel any pain will have a greenwood fracture. Most of the time, the child at least reports pain when pressure is applied to the area directly above the hernia.

If there is any uncertainty as to whether a fall has resulted in a fracture, a doctor should definitely be consulted.

The treatment

Treatment for a greenwood fracture depends on the severity of the break.

With the frequent uncomplicated fractures, it is sufficient to immobilize the affected area for some time using a plaster cast or splint. The fracture then heals completely on its own. Even in the case of a slight misalignment, treatment can often be conservative, i.e. without surgery. The broken ends can be pulled apart under light anesthesia and brought back into the correct starting position. A plaster of paris or a splint for immobilization can then be attached here as well.

In the rare but serious cases, however, surgery is often necessary. If a joint is affected by the fracture or there is a significant deformity, it must be treated surgically.

It is also possible that a plaster of paris or a splint alone cannot fix the ends of the bones sufficiently. Another important indication for surgery is an externally visible injury from the ends of the fracture, the so-called open fracture. An open break is always an indication for surgery and must be treated as quickly as possible because of the risk of infection.

You might also be interested in this article: Homeopathy for broken bones.

Growth disorder as a complication disorder

Bone fractures in particular, which run through the growth plates of the bone, the so-called epiphyseal plates, can lead to growth disorders. This can lead to either reduced or increased bone growth at the injured area.
In both cases, this results in a malalignment of the bone, which may have to be treated surgically and can have permanent consequences.

Incorrectly treated fractures can also lead to growth disorders. For example, a fracture immobilized in a malposition can lead to healing of the bone in a tilted position. This can also have permanent consequences and require several years of orthopedic treatment.

How long should the cast be worn?

The plaster of paris or splint should be worn for a maximum of six weeks for simple fractures. Usually, however, three to five weeks are sufficient for the fracture to heal. If the cast is worn for more than six weeks, the muscles of the affected extremity may recede.

After removing the plaster cast, you should avoid putting excessive strain on the affected extremity, such as when exercising, for about two weeks.

Find out more about the topic here: Plaster of paris.

What is the prognosis?

The prognosis for a child's greenwood fracture is usually very good. Precisely because the bone is still growing, healing takes much shorter than in adults. Usually the fracture heals without consequences after six weeks at the latest.

In the case of more serious fractures, which also affect the growth plates, for example, there can also be long-term consequences for bone growth. These fractures then require many years of orthopedic therapy and control.

What is the difference to a bead break?

The bulge fracture is also one of the fractures in children. However, there is no fracture gap on the X-ray, as is the case with the greenwood fracture, but a kind of bone bulge.This is caused by a compression of the bone, as occurs, for example, when falling on the outstretched arm.

The bulge fracture also only occurs due to the special elasticity of the child's bone. A bulge fracture can almost always be treated therapeutically with a cast. The prognosis is good.

You can read more about the bead break here: Bulge break