Teaching Case

Trauma of the forearm in a child

A 4 year old little boy is suffering from pain in the arm after a fall. An X ray of the forearm is performed.

Fractures of the children differ from those in adults in several ways. They are often incomplete without any cortical disruption .They have a greater capacity for remodeling than do adult’s bone, which allows for less exact corrective angulation. Children’s bones are stronger than those of the adults with thicker periosteum. Greenstick fracture is specific to the child’s immature skeleton trauma and is a response to longitudinal stress. The trauma breeds forces causing microfractures on the convex side of the bone. The force is removed before a macrofracture ensues. These fractures cause incomplete interruption of the shaft of the injured bone. They perforate one cortex and ramifie within the medullary bone. They may commonly become converted to complete fractures. Typical locations of greenstick fractures are the proximal metaphysis or diaphysis of the tibia and the middle third of the radius and ulna. This kind of fracture is to be recognized earlier avoiding long term angulation complications.