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Greenstick fracture

A fracture when one side of the fractured bone has broken and the other side is bent is called a greenstick fracture. Because of this condition, it is called an incomplete break. This is also known as growth plate injury. Children's bones are still in a developing stage and are more susceptible to greenstick fracture because their bones are more pliable than adults'. This can be compared to the breaking of a fresh branch of a tree. The inner side remains intact even though it is bent while it snaps on one side. It wont result in a complete disruption of the bone's cortex but there will be a bowing at the fractured area.

To bring back the bone into proper position, it has to be bent back and this procedure is called reduction.

A cast for about six weeks will help regain the position. Since greenstick fractures mostly occur in the middle and slower growing parts of the bone, it takes longer time to heal. In a growth plate injury, careful treatment and accurate reduction are necessary for the bone to continue to grow normally. In some cases, plastic deformation of the bone also may occur. This is a condition in which the bone permanently bends but does not break. For such injuries, an osteotomy or bone cut may be necessary to realign the bone if the fracture is a fixed one.

Normally when children fall with outstretched arms, they suffer injuries or broken bones in their hand, wrist, arm and elbow. The orthopedist will request an X-ray of the injured parts. He will also conduct some tests to ensure that blood circulation and nerves in the affected portions are not affected due to the injury. Some symptoms include acute pain, tenderness, swelling, inability to rotate or turn the forearm and any type of deformity about the elbow, forearm or the wrist. Depending on the type of fracture and the degree of displacement, the doctor will decide about the treatment. A surgery is required only if the bones break through the skin and the physician will be able to bring back proper alignment of the bones through manipulation.

Avulsion fracture

A fracture is called an avulsion fracture when the injury occurs in a place where a tendon or ligament that attaches to the bone pulls off a piece of the bone. It is common to notice avulsion fractures occur around the pelvis area, though they can occur anywhere in the body. More than adults, children are more prone to avulsion fracture, because a child's bone may give away before the ligament or tendon is injured whereas in adults, ligaments get injured more. Children have an area of bone that grows faster. This area in the skeleton is known as a growth plate. When an injury occurs in children near a growth plate, the tendons or ligaments can pull very hard and it will lead to a fracture of the growth plate. Growth plates are necessary for normal skeletal development of a child and so, avulsion fractures must be treated with utmost care. Surgery is the only option, to align the growth plate and stabilize it. If there is no danger of lasting growth problems and if the avulsion fracture is well aligned, then surgery is not necessary.


Normally, avulsion fractures can be treated without surgery since it is treated as a soft-tissue injury. An avulsion fracture of the hamstring attachment on the pelvis can be treated in the same way as a hamstring tear. Surgery is considered only when the bone is pulled too far from its original position. Some ankle sprains where the damaged ankle ligaments pull off a tiny piece of a bone from the joint are treated like an ankle sprain. Avulsion fractures in children are more complicated.


Avulsion fracture of the pelvis

Teenagers and sports persons are susceptible to a type of pelvic fracture. Often some of the pulled muscles may end in an avulsion fracture not detected earlier. The muscle in the pelvic area tears away a small piece of bone from the top of the hip bone and there may be sudden muscle contractions. The entire pelvic ring is not involved and there is no injury to the internal organs. Avulsion fractures experienced by athletes are stable fractures and will heal without surgery. Elderly persons with osteoporosis are also at a risk for pelvic fracture. It can occur during a fall or when descending stairs. Normally the pelvic ring is not damaged but any of the individual bones of this ring may be fractured. Mostly these pelvic fractures involve high-energy forces. Motor vehicle accident, crush accident and fall are the major causes for this type of fracture. Pelvic fractures can be life-threatening depending on the amount of force involved.


Acute pain, swelling and bruises are symptoms of pelvic injuries. To avoid aggravating the pain, a patient may walk with a bent knee. There may be injuries to other parts of the body like head, legs or the chest, if the injury is due to trauma. Heavy bleeding can lead to shock should be arrested immediately. The doctor will request for X-rays from different angles to find out the exact degree of displacement to the bones. A CT scan will reveal the extent of other injuries. It is routine to examine the blood vessels and nerves to the legs for any damage due to the injuries.


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Collection of Pages - Last revised Date: August 20, 2019