From the Research
The acceptable degree of angulation in pediatric greenstick fractures is up to 10 degrees, as evidenced by a recent study 1 that achieved satisfactory reduction and high parent satisfaction with closed reduction without anesthesia. When managing these fractures, it's essential to consider the specific bone involved, the child's age, the direction of angulation relative to joint motion, and the distance from the growth plate.
- The remarkable remodeling capacity of children's bones allows for greater acceptance of angulation compared to adults, especially when the fracture is near a growth plate and in the plane of joint motion.
- Younger children have greater remodeling potential than adolescents, allowing for more angulation to be accepted.
- Regular follow-up radiographs are essential to ensure proper healing and to monitor for any progressive deformity that might require intervention. The study 1 included 163 children with closed angulated fractures of the distal radius and fracture shafts of both forearm bones, and found that 96.8% of children achieved ≤10° of residual angulation after closed reduction without anesthesia. Another study 2 suggests that in children less than 9 years of age, complete displacement, 15 degrees of angulation, and 45 degrees of malrotation are acceptable, while in children 9 years of age or older, 30 degrees of malrotation is acceptable, with 10 degrees of angulation for proximal fractures and 15 degrees for more distal fractures. However, the most recent and highest quality study 1 supports the use of up to 10 degrees of angulation as an acceptable threshold for pediatric greenstick fractures.