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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)