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Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Request an X-ray to show the nature of the fracture: Plastic deformation: most commonly associated with the ulna.Greenstick fracture: occurs when one side of a bone breaks as the opposite side is bent, usually where the force was directly applied.Buckle or ‘torus’ fracture: compressive forces cause one side of the bone to ‘buckle’ under pressure as the opposite side is bent.Complete fracture: involves the entire bone and both cortical surfaces.Epiphyseal fracture: involves the growth plate and is classified using the Salter–Harris system. The radial epiphysis may displace dorsally, often in adolescents, to mimic a Colles’ deformity.
Orthopaedics and Fractures
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Children have a reputation for bouncing rather than breaking when they fall and certainly there are specific fracture patterns that only happen in the immature skeleton: Buckle fractures (Fig. 21.93).Greenstick fractures (Fig. 21.94).Injuries to the physis or growth plate (Fig. 21.95).Children’s ligaments are stronger than their bones so avulsion fractures are more common than ruptured ligaments in this age group.The growth plates may be mistaken for fractures so radiographs must be reviewed carefully and matched to the history and the physical signs (Fig. 21.96).
Greenstick fracture
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
This is a greenstick fracture, which is ideally treated with closed reduction. Greenstick fractures tend to occur in children aged 5–14 years, when the bones are softer and more flexible. They are considered incomplete fractures as the bone bends and the fractures do not transverse the outer cortex of the bone. This plastic deformity usually occurs due to a torsional injury and is managed through closed reduction and cast immobilization. After initial casting, serial clinical and radiographic studies are recommended.
Management of pediatric orbital wall fractures
Published in Expert Review of Ophthalmology, 2019
Pediatric inferior orbital wall fractures can be grouped into the two categories of entrapped (‘trapdoor’) fractures and nonentrapped (‘open-door’) orbital fractures [5]. Trapdoor fractures are much more common in the pediatric population because of the elastic, cancellous bone of the immature skull. When fractured, the elastic orbital wall rapidly returns to its previous position, leaving little time for the inferior rectus muscle and other orbital soft tissues to escape entrapment [6]. This type of fracture, also known as a ‘greenstick fracture,’ explains the higher rate of entrapment in this age group. Soft tissue, fat, and/or muscle may become entrapped within the greenstick fracture, thereby limiting ocular motility and resulting in a constrictive environment and risk of ischemic injury to the involved tissue. Ischemia of the extraocular muscle can result in permanent damage and therefore must be treated emergently. Of note, ‘greenstick’ fractures may occur with limitations in ocular motility despite a white and quiet conjunctiva and an absence of external evidence of trauma such as periorbital edema and ecchymosis. Such fractures are known as white-eyed fractures [4].