Green Stick Fracture Treatment

Fracture PatternAnd Movement Patterns

13. Fracture patterns and their significance: Hairline fractures (a):

Hairline fractures result from minimal trauma, i.e. trauma which is just great enough lo produce a fracture but not severe enough to produce any significant displacement or (he fragments. Such fractures may he (I) incomplete or (2) complete.

14. Hairline fractures (b): These fractures may be difficult to detect on the radiographs, and where there arc reasonable clinical grounds for suspecting a fracture, the rides are quite clear: I. Additional oblique radiographic projections of the area may be helpful: 2. Do not accept poor quality films: 3. Films repeated alter 7-10 days may show the fracture quite clearly (due to decalcification at the fracture site).

15. Hairline fractures (e): Stress fractures are generally hairline in pattern and are often not diagnosed with certainly until there is a wisp of subperiosteal callus formation, or increased density at the fracture site some 3-6 weeks alter the onset of symptoms. Hairline fractures generally heal rapidly, requiring only symptomatic treatment, htil the scaphoid and femoral neck are notable exceptions.

Hairline Fracture Scaphoid

16. Hairline fractures (d): Radiograph of upper tibia of an athletic adolescent with a 7 week history of persistent leg pain. Previous radiographs were reported as normal. Note the coned view lo obtain optimal detail and the incomplete hairline fracture revealed by bone sclerosis and subperiosteal callus. A crepe bandage support only was prescribed, and the symptoms settled in a further 6 weeks.

17. Greenstick fractures (a): Greenstick fractures occur in children, but not all children's fractures are of this type. The less brittle bone of the child tends lo buckle on the side opposite the causal force. Tearing of the periosteum and of the surrounding soft tissues is often minimal.

18. Greenstick fractures (b): This radiograph illustrates a more severe greenstick fracture of the distal radius and ulna. Note that although there is about 45° of angulation at the fracture site, there is no loss of bony contact in either fracture. The clinical deformity is clearly suggested by the soft tissue shadow.

Elastic FractureGreenstick Fracture Radius

19. Greenstick fractures (c): Reduction of a greenstick fracture is facilitated by the absence of displacement and by the intact tissues on the concavity of the fracture. Angulation may be corrected by supporting the fracture and applying pressure over the distal fragment (I & 2). The elastic spring of the periosteum may however lead to recurrence of angulation (3). Particular attention must therefore be taken over plaster lixation and aftercare.

20. Greenstick fractures (d): In the forearm in particular, where angulation inevitably leads to restriction of pronation and supination, some surgeons deliberately overcorrect the initial deformity (I). This tears the periosteum on the other side of the fracture (2). This reduces the risks of secondary angulation (3). Healing in all greenstick fractures is rapid.

21. Simple transverse fractures (a):

Transverse fractures run either at right angles to the long axis of a bone (I). or with an obliquity of less than 30°. They may be caused by direct violence, when the bone fractures immediately beneath the causal force (e.g. the ulna fracturing when warding off a blow (a)). They may also result from indirect violence, when the bone is subjected to bending stresses by remotely applied force (e.g. a fracture of the forearm bones resulting from a fall on the outstretched hand (b)).

22. Simple transverse fractures (b): The inherent stability of this type of fracture (illustrated by the model on the right) reduces the risks of shortening and displacement. In the tibia, as a result, weight bearing may be permitted at a comparatively early stage. On the other hand, the area of bony contact is small, requiring very strong union before any external support can be discarded. (NB: The term "simple' used to describe this and the following fractures means that the fracture runs circumferentially round the bone with the formation of only two main fragments.)

23. Simple oblique fractures (a): In an oblique fracture (I) the fracture ains at an oblique angle of 30° or more (O). Such fractures may be caused by (a) direct or (b) indirect violence. In simple spiral fractures (2) the line of the fracture curves round the bone in a spiral. Simple spiral fractures result from indirect violence, applied to the bone by twisting (torsional) forces (t).

24. Simple oblique and spiral fractures (b): In spiral fractures, union can be rapid (I) as there is often a large area of bone in contact. In both oblique and spiral fractures, unopposed muscle contraction or premature weight bearing readily lead to shortening, displacement and sometimes loss of bony contact (2). (Note: In the AO classification of fractures (see later) simple spiral, oblique and transverse fractures are classified as Type A fractures.)

Real Femoral Neck

28. Impacted fractures: A fracture is impacted when one fragment is driven into the other {I). Cancellous hone is usually involved and union is often rapid. The Mobility of these fractures varies and is more implied than real. Displacement will occur if the fracture is subjected to deforming forces, e.g. without lixation. impacted femoral neck fraetures frequently come adrift (2).

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