Stresses and forces can be applied to the porous, compliant bones of children in such a way as to create an incomplete cortical fracture. A greenstick fracture is characterized by cortical disruption and periosteal tearing on the convex side of the bone, with an intact periosteum on the concave side of the fracture. Greenstick fractures are more stable and somewhat less painful than complete fractures, since the area of intact periosteum protects the child from bony crepitance.
The need for reduction is related to the degree of angulation of the fracture, the age of the child, and the anatomic location of the injury. Orthopedic consultation may be helpful in the decision analysis regarding possible reduction and outpatient management.
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