From the Guidelines
Greenstick fractures should be managed with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as stated in a study published in the American Family Physician in 2002 1. The diagnosis of a greenstick fracture is typically based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Key Considerations
- Immobilization with a cast or splint is usually sufficient for greenstick fractures
- Fracture fragments that are small, nonarticular, or minimally displaced do not require surgical intervention
- The goal of treatment is to promote proper healing and prevent complications
Treatment Details
- Immobilization should be maintained for 3-6 weeks, depending on the fracture location and severity
- Pain management can include acetaminophen or ibuprofen as needed
- Cast care instructions should be provided to the patient, including keeping the cast dry and monitoring for signs of complications
- Follow-up should occur within 1-2 weeks for radiographic confirmation of proper healing alignment The management of greenstick fractures prioritizes minimizing morbidity, mortality, and optimizing quality of life, and simple immobilization is the recommended approach for small, nonarticular, or minimally displaced fractures, as supported by the study 1.
From the Research
Greenstick Fracture Management
- Greenstick fractures are most commonly seen in the pediatric population, especially in those under 10 years of age, but can also occur in adults in specific circumstances, such as after physical therapy near drill holes created during surgery 2.
- In adults, greenstick fractures can occur during physical therapy, and physicians and therapists should pay more attention to patients who have undergone implant removal to avoid greenstick fractures, especially in locations near drill holes 2.
- For impacted greenstick fractures of the distal forearm in children, bandage therapy (BT) is a safe technique that allows patients to return to normal activities sooner and have less discomfort compared to cast therapy (CT), although patients treated with BT may experience greater pain at the start of treatment 3.
- Immobilization using casts and splints can have complications, such as stiffness, pressure sores, and compartment syndrome, and the risk of morbidity is higher when casts are applied by less experienced practitioners 4.
- Certain materials and methods of ideal cast and splint application are recommended to prevent morbidity in high-risk patients, including the obtunded or comatose multitrauma patient, the patient under anesthesia, the very young patient, the developmentally delayed patient, and the patient with spasticity 4.
- Treatment of greenstick fractures may involve splinting, as seen in a case report where a patient with a greenstick fracture of the ulnar shaft was treated with splint fixation, resulting in improved pain and range of motion after 2 months 2.