Greenstick fractures - radius and ulna

Case contributed by Leonardo Lustosa

Presentation

Awkward fall onto the hand while playing on a trampoline. Forearm deformity upon physical examination.

Patient Data

Age: 4 years
Gender: Female

Radiographs revealed midshaft greenstick fractures of both forearm bones with dorsal angulation.

The fracture is classified below (see annotated image).

Classification

Annotated image

Practical classification:

  • bone involvement: radius and ulna
  • level: middle third in both bones - likely distal to the pronator teres m. insertion
  • fracture pattern: greenstick fracture in both bones

Case Discussion

Forearm fractures are the most common long bone fractures in children. Fall onto the outstretched hand is the main mechanism of injury. Due to skeletal immaturity, they may present as greenstick fractures.

Pediatric forearm fractures can be practically classified considering 3 main characteristics:

  • bone involvement: radius, ulna, or both
  • level: distal, middle, or proximal third
  • fracture pattern: complete, greenstickbowing, or comminuted

Unlike adults, most forearm fractures in children can be managed non-operatively.

The reduction maneuver and the position of immobilization can be guided by this simple yet clinically practical classification.

If a middle third radial fracture is present, special attention is given to the pronator teres insertion, which dictates the immobilization position.

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