Greenstick Fracture
Pediatric Incomplete Cortical Bone Fracture
Primary risk age: Toddlers and Children (typically under 10 years)
- Urgency
- Moderate
- Typical age
- Toddlers and Children (typically under 10 years)
- Body system
- Musculoskeletal System
Typical course: 4 to 6 weeks in a cast.
Reviewed against AAP · CDC · WHO · NHS guidance Last reviewed 2026-06-13
1. Summary & Pathophysiology
Pediatric Incomplete Cortical Bone Fracture
Pathophysiology (Development Path)
Because pediatric bones are more porous and contain more collagen than adult bones, they are highly flexible. An applied bending force causes the bone to bend and break on the convex side (outer side) while the concave side (inner side) remains bent but intact, similar to breaking a green branch of a tree.
Primary Causes & Etiology
Falls onto an outstretched hand (FOOSH), direct impact, or twisting force on soft, flexible pediatric bones.
2. Symptom Continuum
- Early Onset Signs
Immediate localized pain following trauma, reluctance to use the affected extremity.
- Progressive Phase
Localized swelling, tenderness over the bone shaft, and visible bruising.
- Severe Indicators
Deformity (angulation) of the limb, intense pain upon movement, and numbness or tingling in fingers or toes.
3. Clinical Verification
Plain radiographs (X-rays) in anteroposterior (AP) and lateral views showing cortical disruption on one side only.
4. Care & Elements Plan
Primary Care Treatment Plan
Immobilization in a cast or splint. If angulation is significant, closed reduction under sedation may be required to realign the bone before casting.
Home Support Elements
Keep the cast dry. Elevate the limb above heart level to reduce swelling. Monitor finger/toe temperature and sensation.
Generic Active Ingredients (No Brands)
- Acetaminophen or Ibuprofen for pain relief.
Lists active elements only. Never administer self-designed therapies.
5. Doctor Critical Lines
Critical Thresholds: When to See a Doctor
Seek medical care immediately after any fall followed by severe pain or swelling. Go to the ER if the limb looks crooked or fingers/toes are cold or blue.
6. Vaccine & Prevention
Routine Prophylaxis (Prevention)
Ensure child safety protocols on playgrounds, use of protective wrist guards and pads during sports, and adequate calcium intake.
Immunization Context
Not applicable.
7. Timelines & Outlook
Active Timeline
4 to 6 weeks in a cast.
Expected Prognosis
Excellent. Children's bones have high remodeling capacity, and these fractures heal completely without residual disability.
Potential Untreated Complications
Malunion (healing at an angle)Compartment syndrome (rare)Persistent deformity if untreated
More in Congenital Dysplasias & Skeletal Deformities
Moderate Developmental Dysplasia of the Hip (DDH)
Congenital Structural Hip Joint Instability
Neonates and Infants (Screened from birth through walking age; more common in girls)
Moderate Congenital Talipes Equinovarus (Clubfoot)
Congenital Foot & Ankle Structural Deformity
Neonates (Apparent immediately at birth; more common in boys)
Mild Pediatric Scoliosis
Adolescent Idiopathic Scoliosis (AIS)
10 to 18 Years (Typically detected during growth spurt)