Green Stick Frxs of Mid 1/3 of Radius & Ulna   


- See: Green Stick Frx

- Discussion:
    - occurs most often in children less than 8 yrs of age as a result of a fall on an outstretched hand;
    - anatomically the frx tends to occur just distal to insertion of pronator teres, and therefore distal fragment is supinated as compared to proximal fragment;
    - greenstick frxs in mid-forearm have both angulatory & rotational component, both of which must be corrected w/ manipulation.
           - plastic deformation may occur to either the ulna or radius;
    - usual deformity is dorsal angulation of distal fragments w/ apex of fracture toward the volar aspect;

- Radiographs:
    - rotational alignment:
           - note differences in fracture cortical surfaces;
           - note relationship of bicipital tuberosity to radial styloid;

             

- Treatment:
    - usual deformity is dorsal angulation of distal frag w/ apex of frx toward volar aspect;
    - simple straightening of the bones and immobilization in the cast is not adequate, as the deformity will recur;
    - intact cortex should be completely broken thru during a slow process of plastic deformation over 5 minutes;
           - this may require GEA if forearm rotation is limited;
    - reduction involves pronation of the distal fragment as well as correction of the apex volar angulation;
    - children < age 4 can tolerate a larger deformity, since they have greater remodeling potential;
    - following completion frx, periosteal tube remains intact and holds the fragments together in normal alignment (hence frx is relatively stable);
    - long arm cast is applied w/ elbow in 90 deg of flexion & forearm in 45 deg pronation (to prevent supination of distal fragment)



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, January 4, 2013 11:22 am