title: Greenstick fractures of the middle third of the forearm. A prospective multi-centre study.
abstract: BACKGROUND
  Greenstick fractures suffered during growth have a high risk for refracture and posttraumatic deformity, particularly at the forearm diaphysis. The use of a preemptive completion of the fracture by manipulation of the concave cortex is controversial and data supporting this approach are few.
  
  
  OBJECTIVE
  Aim of this study was to determine the factors which predispose to refracture and deformities, and to define therapeutic strategies.
  
  
  METHODS
  We prospectively gathered clinical and radiographic data over a period of one year on greenstick fractures of the middle third of the forearm in children as part of a multi-centre study. Endpoint was a follow-up visit at one year. Radiographic deformity, state of consolidation at resumption of physical activities and refracture rate were analysed statistically (ANOVA, Student's t-test and Pearson's chi-square test) with regard to patient age, gender, fracture type, therapy and time in plaster.
  
  
  RESULTS
  We collected the data of 103 patients (63 boys, 40 girls), average age 6.6 years (1.3-14.5 years), the vast majority of whom had a combined greenstick fracture of the radius and ulna. 6.7% of the patients sustained a refracture within 49 days (29-76) after plaster removal. They were significantly older (p=0.017) with a significantly higher incidence of manual completion of the fracture with radiographic signs of partial consolidation (p=0.025). Residual deformities were significantly smaller after completion of the fracture compared to reduction without completion (p=0.019) or plaster fixation alone (p<0.005).
  
  
  CONCLUSIONS
  Completion of a greenstick fracture does not prevent refracture. Nevertheless, it diminishes the extent of secondary deformities in cases where the primary angulation exceeds the remodelling capacity. Prevention of refracture should include a routine radiographic follow-up 4-6 weeks after injury with continuation of plaster fixation in cases of partial consolidation.
authors.affiliation: District Hospital Langenthal, Department of Orthopaedics, Langenthal, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Schmuck
authors.forename: S
authors.initials: S
authors.lastname: Altermatt
authors.forename: P
authors.initials: P
authors.lastname: Büchler
authors.forename: D
authors.initials: D
authors.lastname: Klima-Lange
authors.forename: A
authors.initials: A
authors.lastname: Krieg
authors.forename: N
authors.initials: N
authors.lastname: Lutz
authors.forename: J
authors.initials: J
authors.lastname: Muermann
authors.forename: T
authors.initials: T
authors.lastname: Slongo
authors.forename: R
authors.initials: R
authors.lastname: Sossai
authors.forename: C
authors.initials: C
authors.lastname: Hasler
mesh_terms: D000293:Adolescent; D016723:Bone Remodeling; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*