Welcome to a new PEMBlog feature – Fracture Fridays. Each week I’ll post a new case of a common pediatric orthopedic injury. So, without further ado, here we go.
The case
A preschooler was riding his big sister’s “girl” bike, crashed it and landed on his outstretched hand. A true FOOSH if you will (fell on outstretched hand). His mom brought him to the ED because he was having trouble holding his iPad with the injured arm. An X-Ray is obtained.
The Diagnosis
I started things out with a real obscure one didn’t I? This is, of course, a greenstick fracture. Specifically, this is a buckle or torus fracture which is actually one type of greenstick fracture. The bones of young children are more plastic, and the bone deforms without breaking completely. As you can see in the image above there is a ‘bucking’ of the bone more so towards the dorsal side. Neurovascular injuries in association with this type of fracture are extremely rare.
Management
The management of greenstick fractures consists of splinting or casting, and then just letting the darn thing heal, which in will in about a month. generally there is less soft tissue swelling than with other injuries, so a short arm cast would be a viable option. You could also just as easily place a splint. Though a volar splint is great for nondisplaced nonangulated forearm fractures, in a child of this age a sugartong splint would assure that it is better immobilized and protected until definitive casting. For pain most children require acetaminophen or ibuprofen alone. Pain that is out of proportion to what you’d expect should prompt the search for other injuries.
