A complete fracture of the radius or ulna would be more concerning and frequently require more intervention (reduction/fixation). In this case, I would avoid any temptation to reduce the greenstick deformity. These fractures usually remodel without significant intervention. Having consulted "experts" in the field, it is recommended that these fractures are best left alone by those of us in the Emergency Department. (I'm at peace with that.)
As with all long bone fractures, it is important that you asses the joint above and below the fracture. In this case there was a suggestion of wrist tenderness which should have inspired you to obtain isolated wrist films. With isolated ulnar greenstick fractures you should evaluate for radial head tenderness. This could indicate a "Monteggia Fracture Equivalent" in which case there may have been dislocation followed by spontaneous reduction of the radial head.
http://www.wheelessonline.com/ortho/monteggia_fractures_in_children
Management of otherwise straight forward Greenstick Fractures includes: Splint, sling, and follow up with Ortho (who will likely do nothing more than follow the remodeling process over time.) Wheeless' Orthopedics suggests that fractures of >10-15 degrees angulation may need reduction, but after talking to the professionals, this sounds like rare occurance. Wheeless describes something called "recurrent deformity" which happens when the initial angulation gets worse over time following splint placement. From my point of view, this phenomenna is rare.
Bottom line, if a greenstick needs to be reduced, you should not be the one to make that decision, nor the one to perform the reduction. Punt that one to the pros, "Primum Non Nocere."
Other Pediatric Fractures of the extremities:
-Torus or "buckle" fractures; are pretty much benign.
-Physeal or "growth plate" fractures; REMEMBER Salter Harris Classification??? (Will be discussed in a following blog...Stay tuned.)
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And for your reading pleasure...
Q. What do you call 2 orthopaedic surgeons reading an ECG.
A. A double blind trial.
Q. How do you hide a $20 bill from an Orthopaedic Surgeon?
A. Put it in a Textbook.
- 3 orthopedic surgeons took 5 days to do a jig-saw puzzle and were proud of the accomplishment.
(When asked why they were so proud they said it was was because the box said 3-5 years.)
- What's the difference between a carpenter and an orthopedic surgeon?
(A carpenter knows more than one Antibiotic.)
- How do you spot an orthopedic surgeon's car in the parking lot?
(It's the porsche with a comic book on the back shelf.)
- What's the difference between a rhinoceros and an orthopedic surgeon?
(one is thick skinned, small brained and charges a lot for no good reason...the other is a rhinoceros.)
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