Anatomy Msk · Year 1 · from Anatomy Msk
Case 2: Pediatric Greenstick Fracture
Clinical Image
Source: Wikimedia Commons - Greenstick Fracture - Public Domain
Case Presentation
A 6-year-old boy is brought to the urgent care clinic after falling off monkey bars at the playground. He landed on his outstretched left hand and immediately complained of pain in his forearm. He is holding his arm protectively and refuses to let anyone touch it. Physical examination reveals mild swelling and tenderness over the dorsal aspect of the distal left radius. There is no obvious deformity, and neurovascular examination is intact with good radial pulse and capillary refill. Radiographs demonstrate a greenstick fracture of the distal radius with cortical disruption on the tension (dorsal) side and intact cortex on the compression (volar) side, with slight dorsal angulation. The fracture is reduced with gentle manipulation under procedural sedation and immobilized in a short arm cast. Follow-up radiographs at 3 weeks show good callus formation and healing. This case demonstrates the unique properties of pediatric bone.
Key Learning Points
- Pediatric bones have a higher proportion of organic matrix (collagen) to mineral content compared to adult bones
- This composition makes children's bones more flexible and prone to incomplete fractures (greenstick, buckle/torus)
- Greenstick fractures show cortical disruption on one side with bending on the opposite side
- The periosteum in children is thicker and stronger, often remaining intact and aiding fracture reduction and healing
- Children's bones heal faster due to thicker, more vascular periosteum and active growth plates