- 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);
