$greenstick fracture distal radius$

The distal radio-ulnar joint dislocates with a fracture occurring at the junction of distal 1/3 rd and middle third of radius.The radiograph below shows a mid-shaft fracture (arrowed) The usual choice of fixation in paediatric forearm fractures is flexible intramedullary nails that are introduced percutaneously and removed at a later date.Failure to maintain reduction (If the reduction slips out in cast, on check radiographs taken within a week).Failure to reduce by closed methods due to soft tissue interposition.The fractures have to be reduced internally by surgery when there is:.Rotational alignment is the most difficult to achieve, sometimes due to inherent plastic deformation.Manipulation to reasonable apposition of the displaced bones is usually sufficient.The classic treatment for these Greenstick fractures is to ‘complete’ the fractures under general anaesthetic and application of an above elbow cast.Almost half of them are Greenstick fractures.Mechanism is fall on to extended wrist and extended elbow.These fractures involve the diaphyses of the radius and ulna.The radiograph below shows a supracondylar fracture (arrowed) and the insertion of K wires after manipulation. Manipulation of the elbow should never be attempted while placing the initial POP back slab.A child presenting with traumatic elbow swelling should be assessed immediately for capillary refill, distal neurovascularity and a Plaster of Paris (POP) back slab applied in the same resting position of the elbow.Brachial arterial injury can also occur, although rarely, following reduction of a supracondylar fracture by closed methods.Displaced supracondylar fractures without any obvious nerve or vessel injury should be manipulated and fixed with K wires, taking care not to cause iatrogenic injury to the nerves (especially the ulnar nerve).There are two types - Extension (more than 90%) and Flexion – depending on the position of the distal fragment relative to the humeral shaft.They are also notorious to malunite (progressive deformation after union) posing late problems. They are important to recognise and treat promptly and appropriately because of the potential to vascular (brachial artery) or nerve injury (most commonly Anterior Interosseous Nerve) or both.

$greenstick fracture distal radius$

Most common fracture (> 50% of fractures) around elbow in children.Generally, if the child is more than 10 years of age, even minor degrees e.g., 15° or more of angulation is not acceptable.

$greenstick fracture distal radius$

Controversies exist in the acceptable angles of deformities around the distal radial physis.

If the fracture involves the physis, then Salter-Harris type II is the most common pattern.

Greenstick fracture – when the incomplete deformation or partial break occurs on the tension side of the bone – here it would be the volar cortex usually occurs in mid-shaft.

The radiograph below shows a distal radius fracture (arrowed) When the dorsal cortex breaks under compression and the other (volar) remains intact, this pattern is then called a ‘Torus’ fracture. This compresses the extensor side of the cortex dorsal and tenses the flexor (volar) side of the bone. The usual mechanism is a fall on the outstretched hand with the wrist in extension.

Torus fracture - Buckle fracture is the most common pattern.

Mostly in the region of metaphysis than involving the physis.

Follows a simple fall – most common mechanism.

$greenstick fracture distal radius$

Greenstick fracture distal radius