Greenstick and Buckle Fractures

What is a Greenstick Fracture?

A greenstick fracture is a type of fracture that is incomplete. It occurs when the bone bends and cracks on one side without breaking completely through to the other side. This term derives from the way a young, flexible branch (like a green stick) can bend and partially break without snapping entirely. Greenstick fractures are most commonly seen in children due to their softer, more pliable bones.

Normal arm x-ray. X-rays are used to determine if there is a buckle / greenstick
fracture

What is a Buckle Fracture?

A buckle fracture, which is also known as a torus fracture, is another type of incomplete fracture commonly occurring in children. This fracture happens when one side of the bone compresses and bulges outward without breaking completely. It typically results from a fall or a direct impact, causing the bone to crumple or buckle at the site of the injury.

How Do Greenstick and Buckle Fractures Differ from Other Fracture Types?

  • Incomplete vs. Complete: Both greenstick and buckle fractures are considered incomplete fractures, meaning the bone does not break all the way through. In contrast, most other fracture types (such as comminuted, transverse, or spiral fractures) involve a complete break in the bone.
  • Mechanism of Injury: Greenstick fractures often result from bending forces, while buckle fractures typically occur due to compression or axial loading. Other fracture types can occur from various forces, including twisting or high-impact trauma.
  • Age of Occurrence: Greenstick and buckle fractures are more prevalent in children due to their developing bones. In contrast, older individuals may experience more complete fractures as bones become more brittle with age.

Prevalence of Greenstick and Buckle Fractures in Children

  • Greenstick and buckle fractures are quite common in pediatric populations.
  • Greenstick Fractures: These are especially prevalent in younger children, typically under the age of 10, due to the flexibility of their bones.
  • Buckle Fractures: These also commonly occur in children and are particularly frequent in those aged 3 to 10 years.
  • Overall, these types of fractures are more common in children than adults because children’s bones are still growing and are generally more flexible and softer.

Both types of fractures generally heal well with appropriate treatment, often requiring immobilisation with a cast or splint to ensure proper recovery.

Greenstick and Buckle fractures
Greenstick and Buckle fractures are commonly seen in children in the forearm.

Locations of Greenstick and Buckle Fractures

Greenstick and buckle fractures are most commonly seen in the following areas of the body, particularly in children:

  • Forearm (Radius and Ulna):
    • These fractures frequently occur in the forearm, specifically in the radius and ulna, due to falls or direct impacts during activities like sports or play. The bending and compressive forces exerted during these events often lead to greenstick or buckle fractures.
  • Wrist (Distal Radius):
    • The distal radius is another common site for these types of fractures. Falling onto an outstretched hand can cause the wrist to buckle or the bone to bend, resulting in these specific fracture types.
  • Tibia (Shin Bone):
    • Greenstick fractures can also occur in the tibia, especially in younger children, due to their softer bones. A fall or direct blow to the shin can cause a greenstick fracture in this area.
  • Other Long Bones:
    • While less common than in the forearm and tibia, greenstick and buckle fractures can also occur in other long bones of the body, such as the femur (thigh bone) or humerus (upper arm bone), particularly in young children during falls or sports activities.

Overall, greenstick and buckle fractures are most frequently found in the forearm and wrist, making these areas particularly susceptible to injuries in children due to their active lifestyles and the flexibility of their developing bones.

Symptoms and Causes

Common Causes of Greenstick and Buckle Fractures of the Radius and Ulna

  • Falls:
    • Children often fall while playing, running, or climbing, leading to wrist or forearm injuries as they try to catch themselves with their hands.
  • Direct Impact:
    • A direct strike to the forearm or wrist, such as from sports equipment (e.g., a baseball bat or hockey stick), can cause these fractures.
  • Twisting Injuries:
    • Sudden twisting motions during activities can lead to greenstick fractures, especially if the arm is in a vulnerable position.
  • Accidents:
    • Bicycle accidents, skateboarding, or other recreational activities may result in falls that cause fractures of the radius and ulna.

Risk Factors for Developing Greenstick and Buckle Fractures

  • Age:
    • Children aged 3 to 10 years are at a higher risk due to the flexibility of their bones and the high level of physical activity.
  • Activity Level:
    • Active children who engage in sports, outdoor play, and other physical activities are more prone to falls and injuries that can lead to fractures.
  • Bone Development:
    • Conditions that affect bone health, such as nutritional deficiencies (like low calcium or vitamin D), may increase the risk of fractures.
  • Previous Fractures:
    • A history of previous fractures may indicate weaker bones, putting children at higher risk for future fractures.

Signs and Symptoms of Greenstick and Buckle Fractures

  • Pain:
    • Localised pain in the wrist or forearm, which may be sharp and increase with movement.
  • Swelling:
    • Swelling around the affected area, particularly at the site of the injury.
  • Bruising:
    • Discoloration of the skin (bruising) may occur around the fracture site.
  • Deformity:
    • In some cases, there may be a visible deformity or abnormal position of the wrist or forearm.
  • Limited Range of Motion:
    • Difficulty moving the wrist or fingers, particularly when grasping or using the affected arm.

Potential Complications of Untreated Greenstick and Buckle Fractures

  • Malunion or Nonunion:
    • If not treated properly, the fracture may heal incorrectly (malunion) or not heal at all (nonunion), leading to lasting pain or functional limitations.
  • Growth Disturbances:
    • Untreated fractures in children can lead to uneven bone growth, resulting in limb length discrepancies or deformities.
  • Chronic Pain:
    • Ongoing pain or discomfort in the wrist or forearm may persist if the fracture is not addressed appropriately.
  • Infection:
    • In cases of open fractures (where the skin is broken), the risk of infection is high; this can lead to more serious complications.
  • Loss of Function:
    • Long-term consequences may include a reduced range of motion or strength in the affected wrist or forearm, which can impact daily activities and quality of life.

It’s crucial to seek medical attention if a fracture is suspected. A proper diagnosis and treatment plan minimises the risk of complications. Access Ortho offers rapid appointments for known and suspected fractures. 

Diagnosis and Tests

How are Greenstick and Buckle Fractures Diagnosed?

Diagnosing greenstick and buckle fractures typically involves a medical history, physical assessment and the use of imaging techniques. Access Ortho provides specialist orthopaedic assessment and treatment for fractures. The following steps are typically taken to diagnose a greenstick or buckle fracture. 

  • Medical History:
    • The healthcare provider will ask about the mechanism of injury, the time of injury, and any symptoms experienced, such as pain, swelling, or limited mobility.
  • Physical Examination:
    • A thorough examination of the affected arm or wrist will be performed to assess for tenderness, swelling, bruising, and range of motion. The provider may also check for any visible deformities.

Imaging Techniques Used to Identify Greenstick and Buckle Fractures

  • X-rays:
    • Standard X-rays are the primary imaging technique used to diagnose greenstick and buckle fractures. They can reveal the presence of a fracture and help determine its type.
    • In greenstick fractures, X-rays may show a fracture line on one side of the bone, while in buckle fractures, the X-ray will typically display a bulging or buckling on the bone’s surface without a complete break.
  • Ultrasound:
    • In some cases, especially for younger children, ultrasound may be used as an alternative imaging method to identify fractures, particularly because it does not involve radiation. However, it is not as commonly used as X-rays for diagnosing fractures.
  • MRI or CT Scans:
    • While rarely necessary for diagnosing greenstick or buckle fractures, MRI or CT scans may be used if associated soft tissue injuries are thought to be present or if the fracture is complicated.

Differentiating Greenstick and Buckle Fractures from Other Bone Injuries

  • Fracture Characteristics:
    • Greenstick Fractures: Typically present as an incomplete fracture with a bend on one side of the bone; the fracture line may be visible on X-ray, showing a break on one side without full disruption.
    • Buckle Fractures: Show a bulging appearance on the bone without a complete fracture line; they indicate compression rather than bending.
  • Symptoms:
    • Both types of fractures may present with similar symptoms (pain, swelling, bruising), but the specific mechanism of injury (e.g., falls vs. direct blows) can help differentiate between them.
  • Age Consideration:
    • Greenstick and buckle fractures are more common in children due to their flexible bones, while other fracture types (e.g., complete fractures) are more frequently seen in adults or older children and adolescents.
  • Imaging Results:
    • Radiographic findings can help distinguish these fractures from others. For example, complete fractures, such as comminuted or transverse fractures, will show clear breaks that extend completely through the bone.

Proper diagnosis is essential for ensuring appropriate treatment and recovery. Access Ortho offers urgent care for fractures. 

Specific Considerations

Why Are Greenstick and Buckle Fractures More Common in Children?

  • Bone Composition:
    • Children’s bones are still developing and are generally more flexible and softer than adult bones. This increased flexibility makes them less likely to break completely under stress, leading to more incomplete fractures, such as greenstick and buckle fractures.
  • High Activity Levels:
    • Children are often very active and engage in activities such as running, climbing, and playing sports. These activities increase the likelihood of falls and impacts, which can lead to fractures.
  • Growth Plate Vulnerability:
    • The growth plates (epiphyseal plates) in children’s bones are areas of developing cartilage that eventually turn into bone. These growth plates can be more susceptible to injury, which can contribute to fractures in the surrounding bone.
  • Lack of Coordination:
    • Younger children are still developing their coordination. Poor coordination and balance can increase the frequency of falls and accidents; these can result in fractures.

Anatomical Locations Prone to Greenstick and Buckle Fractures

  • Forearm (Radius and Ulna):
    • The radius and ulna are the most common sites for greenstick and buckle fractures in children, especially after falls where the child tries to break the fall with their hands.
  • Wrist (Distal Radius):
    • The distal radius, near the wrist, is also frequently affected. Falls onto an outstretched hand can lead to buckle fractures in this area.
  • Tibia (Shin Bone):
    • Greenstick fractures can occur in the tibia due to falls or direct impacts to the lower leg, particularly in younger children.
  • Humerus (Upper Arm Bone):
    • While less common, buckle or Greenstick fractures can also occur in the humerus, especially during falls or while playing sports.

Impact of Greenstick and Buckle Fractures on Bone Growth

  • Potential for Growth Disturbances:
    • Greenstick and buckle fractures typically do not significantly interfere with growth if appropriately treated. However, if the fractures are not properly managed, there is a risk of growth disturbances. For example, improper healing may lead to malalignment or deformities that could affect the bone’s growth.
  • Timing of Injury:
    • Fractures that occur close to growth plates can impact the future growth of the affected limb. If a growth plate is damaged during a fracture, it can lead to uneven growth or limb length discrepancies as the child continues to grow.
  • Healing Process:
    • The healing process for greenstick and buckle fractures is generally straightforward. They often heal well with appropriate immobilisation and care. Successful healing allows for normal bone development, and children typically regain full function without long-term complications.
  • Monitoring:
    • Regular follow-up and monitoring after a fracture is important to ensure proper healing and alignment, allowing for normal growth and development as the child matures.

Proper diagnosis and treatment help to prevent long-term impacts on bone growth and overall function. Access Ortho offers specialist orthopaedic care for musculoskeletal injuries. 

Management and Treatment

Conservative Treatment Options for Greenstick and Buckle Fractures

  • Rest:
    • Children may need to avoid activities that could put stress on the injured bone. Resting the bone may help it heal. 
  • Ice Therapy:
    • An ice pack applied over the affected area can help reduce swelling and pain. Ice packs should be applied for 15–20 minutes at a time, several times a day, especially within the first 48 hours after the injury.
  • Elevation:
    • Keeping the injured arm or leg elevated above heart level can help minimise swelling.
  • Casting:
    • A cast may be used to provide support and limit movement, particularly in buckle fractures. Access Ortho offers a variety of casting options to allow for swelling and comfort.

When is Immobilisation Necessary for Greenstick and Buckle Fractures?

  • Severity of the Fracture:
    • Immobilisation is often necessary if the fracture is moderate to severe or there is a risk of further injury or displacement.
  • Location of the Fracture:
    • Fractures involving the radius, ulna, or distal radius usually require immobilisation to maintain alignment and stability during healing.
  • Presence of Pain or Swelling:
    • If significant pain and swelling persist, immobilisation may be recommended to ensure comfort and prevent further movement.
  • Healthcare Provider’s Assessment:
    • The decision to immobilise will be based on the medical assessment, which includes determining the type of fracture and the child’s overall condition. The Access Ortho medical team are specialists in orthopaedics and provide expert care for fractures.
Greenstick and Buckle Fractures
Immobilisation is required following most Greenstick and Buckle Fractures

Pain Management Strategies for Greenstick and Buckle Fractures

  • Over-the-Counter Pain Relievers:
  • Medications such as Panadol or Nurofen can help manage pain and reduce inflammation. Always follow the dosage instructions appropriate for the child’s age and weight.
  • Cold Compresses:
  • Ice packs help decrease pain and reduce swelling. To protect the skin, wrap the packs in a cloth.
  • Positioning:
  • Encouraging the child to find comfortable positions that reduce pressure on the injured area can help manage pain.
  • Distraction Techniques:
  • Engaging the child in calm activities, such as reading or watching a movie, can help divert their attention from pain.

Rehabilitation Exercises for Greenstick and Buckle Fractures

Typically, most patients regain range of motion and strength rapidly following a period of immobilisation after a greenstick or buckle fracture. The medical team will advise on activities to avoid and when return to sport and other activities can occur. On occasion, therapy may be needed to assist with regaining pre-injury levels of function. 

Prevention

Strategies to Prevent Greenstick and Buckle Fractures in Children

Importance of Proper Nutrition in Bone Health and Fracture Prevention

  • Calcium and Vitamin D: Adequate calcium and vitamin D intake is crucial for bone health, as they help build and maintain strong bones. 
  • Balanced Diet: A well-rounded diet provides essential nutrients that support overall growth and bone development, reducing the risk of fractures.
  • Hydration: Proper hydration is also important for maintaining overall health and physical performance, which can help prevent accidents and injuries during physical activities.

Safety Measures in Sports and Play to Reduce Fracture Risk

  • Supervision: Adult supervision during play and sports can help children follow safety rules and engage in appropriate activities.
  • Protective Gear: Encouraging appropriate protective gear, such as helmets, elbow pads, and wrist guards, can reduce the risk of injuries during activities.
  • Safe Play Environments: Creating safe play environments, such as soft landing surfaces (like grass or rubber mats) and ensuring play areas are free of hazards can help minimise the risk of falls and accidents.
  • Education on Safe Practices: Teaching children about safe practices during sports and play, including proper techniques and awareness of their surroundings, can help prevent injuries.

Outlook / Prognosis

Expected Recovery Time for Greenstick and Buckle Fractures

General Recovery Timeline:

  • The expected recovery time for greenstick and buckle fractures is typically 4 to 6 weeks. This can vary based on the child’s age, the location and severity of the fracture, and adherence to treatment protocols.

Initial Healing:

  • During the first few weeks, the child may need to rest and be advised to avoid activities that stress the affected area. Follow-up appointments will help monitor the healing process through physical examination and imaging if necessary.

Complete Recovery:

  • Full recovery, including the return to normal activities and sports, may take additional time, often up to 3 months. Rehabilitation exercises to restore strength and range of motion typically commence once the fracture has stabilised.

Long-Term Prognosis for Children with Greenstick and Buckle Fractures

Excellent Prognosis:

  • The long-term prognosis for children with greenstick and buckle fractures is generally excellent. Most children heal completely without lasting effects, and there is often no significant impact on growth or development if the fractures are treated appropriately.

Growth Considerations:

  • If properly managed, these types of fractures usually do not interfere with the growth plates, meaning that children typically experience normal bone growth and development post-recovery.

Monitoring:

  • Ongoing monitoring may be necessary to ensure that the child’s growth continues appropriately, especially if the fracture occurred near a growth plate.

Potential for Remodelling in Greenstick and Buckle Fractures

  • Natural Bone Remodelling:
    • One remarkable aspect of pediatric fractures is the ability of children’s bones to remodel as they grow. Due to their incomplete nature, Greenstick and buckle fractures have a high potential for remodelling during the healing process.
  • Mechanism of Remodelling:
    • As the child grows, the bone can gradually reshape itself, correcting any minor malalignments caused by the fracture. This process is facilitated by the dynamic nature of growing bones, where the surrounding bone tissue adapts to changes in shape and stress.
  • Impact on Functionality:
    • Most children do not experience functional limitations post-recovery, and any residual deformities from the fracture tend to correct themselves over time due to their bones’ remodelling capability.

In summary, Greenstick and buckle fractures generally have a short recovery time, an excellent long-term prognosis, and a significant potential for natural remodelling, making them less concerning than other more severe fracture types in children. Proper treatment and monitoring play essential roles in ensuring successful outcomes.

Most children will make a full recovery with no long term effects following a Buckle or
Greenstick Fracture.

When to Seek Medical Attention

Signs That Indicate Immediate Medical Care is required

While greenstick and buckle fractures are generally less severe than complete fractures, certain signs and symptoms may indicate the need for immediate medical attention:

  • Severe Pain:
    • Intense pain that does not decrease with rest or over-the-counter pain medication may indicate a more serious injury or complications.
  • Deformity:
    • Visible deformity in the wrist or forearm, such as abnormal bending or alignment, requires prompt evaluation.
  • Swelling and Bruising:
    • Rapid swelling and extensive bruising that worsen over time can indicate complications or associated injuries.
  • Loss of Function:
    • Inability to move the fingers, wrist, or forearm, or loss of sensation in the hand may suggest nerve damage or more serious injuries. In young children you will often see them preferencing using the other arm. 
  • Open Fracture:
    • If the bone protrudes through the skin, this is a medical emergency, as it poses a high risk for infection and requires immediate care in an emergency department.
  • Signs of Infection:
    • Symptoms such as increased redness, warmth, swelling around the injury site, or fever may indicate an infection, especially if there is an open fracture.

Follow-Up Appointments and Monitoring for Greenstick and Buckle Fractures

  • Initial Follow-Up:
    • A follow-up appointment is typically scheduled within 1 to 2 weeks after the injury to assess the healing process and adjust treatment if necessary. This may include X-rays to monitor bone alignment. Access Ortho will arrange follow-up appointments in the clinic. 
  • Regular Monitoring:
    • Subsequent follow-ups may be required to ensure that the fracture is healing correctly. Follow-up appointments will depend on the fracture and the child’s overall condition.
  • Assessment of Functionality:
    • During follow-up visits, healthcare providers will evaluate the child’s range of motion, pain levels, and overall function of the affected limb. This helps determine when rehabilitation exercises can begin.
  • Long-Term Monitoring:
    • In some cases, long-term monitoring may be advised to ensure that the child’s growth and bone development proceeds normally, particularly if the fracture was near a growth plate. Access Ortho will advise if long-term monitoring is necessary.

By being vigilant for signs that indicate complications and adhering to follow-up appointments, parents and caregivers can ensure proper management and recovery of greenstick and buckle fractures, facilitating the best possible outcomes for their child.

Understanding Fracture Clinics

What Is a Fracture Clinic?

A fracture clinic, such as Access Ortho, is a specialised medical facility that focuses on diagnosing, treating, and managing fractures and related injuries. Access Ortho is staffed by orthopedic surgeons and orthopedic nurse practitioners experienced in managing musculoskeletal injuries. A fracture clinic such as Access Ortho aims to ensure proper healing, monitor recovery, and provide rehabilitation support for patients with fractures.

When Should You Visit a Fracture Clinic for a Greenstick or Buckle Fracture?

You should visit a fracture clinic, or other medical provider, for a greenstick or buckle fracture in the following situations:

  • Initial Diagnosis:
    • If a healthcare provider suspects a fracture after an injury, they may refer the child to a fracture clinic for further evaluation and treatment. Fracture Clinics such as Access Ortho offer specialist orthopaedic care, which is important to minimise complications. 
  • Persistent Pain or Swelling:
    • If the child continues to experience significant pain, swelling, or discomfort after an initial assessment or treatment, a visit to the fracture clinic is warranted. Access Ortho offers rapid appointments for suspected fractures.
  • Monitoring Healing:
    • Follow-up appointments will be scheduled at Access Ortho, fracture clinic, to monitor the healing process.
  • Assessment of Functionality:
    • If there are concerns about the child’s ability to move the affected limb, or if there are changes in sensation, a visit to an orthopaedic fracture clinic is important. Access Ortho provides urgent care for fractures.

What to Expect During a Fracture Clinic Appointment for a Child with a Greenstick or Buckle Fracture

When you attend a fracture clinic such as Access Ortho, you can expect the following:

  • Medical History Review:
    • The healthcare provider will ask about the injury, symptoms, and any previous medical history relevant to the child’s condition.
  • Physical Examination:
    • A thorough examination of the injury will assess pain, swelling, and range of motion.
  • Imaging Studies:
    • The provider may order X-rays or other imaging studies to evaluate the fracture and ensure proper alignment and healing.
  • Treatment Plan:
    • Based on the assessment, the medical team will discuss the appropriate treatment plan, including recommendations for immobilisation (like a splint or cast), pain management strategies, and timelines for follow-up appointments. Access Ortho offers specialist orthopaedic care for all injuries.
  • Education and Support:
    • Parents and caregivers will receive information about the expected recovery process, signs of complications to watch for, and any necessary lifestyle modifications during the healing period.
  • Follow-Up Scheduling:
    • An appointment for follow-up visits will be scheduled to monitor the child’s progress and ensure proper healing.

By understanding the purpose of a fracture clinic and what to expect during an appointment, parents and caregivers can better manage a child’s greenstick or buckle fracture and facilitate a smooth recovery. Access Ortho aims to make diagnosing and treating buckle and greenstick fractures easy and convenient. Access Ortho treats adults and children of all ages.

Commonly Asked Questions

Can adults get greenstick or buckle fractures?

Greenstick and buckle fractures are primarily seen in children due to their softer, more flexible bones. Adults typically experience complete fractures because their bones are less malleable and more brittle. However, adults can sustain similar injuries in cases of extreme trauma or conditions that affect bone density.

How long does it take for a greenstick fracture to heal completely?

A greenstick fracture typically heals within 4 to 6 weeks. The exact time may vary depending on the severity of the fracture, the child’s age, and how well the child follows treatment recommendations.

Is a cast always necessary for a buckle fracture?

A cast is typically required for a buckle fracture. The decision to cast will depend on the specific case and the healthcare provider’s assessment. Access Ortho are specialists in orthopaedic care and can guide you on the best course of treatment. Access Ortho offers a variety of casting options.

Can a child with a greenstick fracture still participate in sports?

A child with a greenstick fracture should avoid participating in sports or any high-impact activities until cleared by a healthcare provider. This ensures proper healing and minimises the risk of further injury. Participation in certain activities should be discussed with your medical team.

What’s the difference between a greenstick fracture and a complete fracture?

A greenstick fracture is an incomplete fracture. The bone bends and cracks on only one side without breaking completely, resembling a green twig. In contrast, a complete fracture involves the bone breaking all the way through, resulting in two or more separate pieces.

Are greenstick fractures more painful than other types of fractures?

Greenstick fractures are generally not considered more painful than complete fractures. However, the pain experienced can vary depending on the injury’s location and the child’s pain tolerance.

Can a greenstick fracture heal on its own without treatment?

While some minor greenstick fractures may heal with minimal intervention, proper treatment, such as immobilisation, is generally recommended to ensure correct healing and alignment. Self-healing without treatment may lead to complications or improper healing.

How do you know if a bump or bruise is actually a buckle fracture?

If a bump or bruise is accompanied by significant pain, swelling, limited mobility, or deformity in the affected area, it may indicate a buckle fracture. If you notice any unusual bumps or bruises, it is important to get them assessed to ensure an accurate diagnosis. Access Ortho offers rapid appointments for recent injuries.

What activities should a child avoid during recovery from a greenstick or buckle fracture?

During recovery, children should avoid high-impact activities, sports, climbing, and any movements that stress the affected limb. It’s important to follow healthcare provider recommendations to ensure proper healing.

Can repeated greenstick or buckle fractures affect a child’s growth?

Generally, greenstick and buckle fractures do not affect a child’s growth if appropriately treated, as they usually do not involve growth plates. However, if fractures occur repeatedly or involve the growth plates, monitoring by a healthcare provider is essential to ensure that growth is not compromised.