Your child has a broken bone, or fracture, of the forearm, between the wrist and the elbow. The forearm is made up of 2 bones: the radius and the ulna. The radius is on the "thumb side" of the forearm, and the ulna is on the "pinky finger side." This fracture is called a greenstick fracture. It is a partial thickness fracture. It occurs when 1 side of the bone cracks, and the other side only bends without any break. This is a common fracture in children because their bones are softer. It is also called an incomplete fracture.
If a greenstick fracture puts the bone at an angled position, the bone may need to be straightened before applying a splint or cast. This is called reducing the fracture. .The procedure is known as closed reduction and immobilization. It often takes at least 3 weeks for this fracture to heal.
All greenstick fractures need to be kept from moving (immobilized) to prevent repeated fractures, complete fractures, or displacement. Casting is usually done several days after the initial injury. This decreases the risk of the need to recast due to increasing swelling after the fracture. The type of cast depends on the location of the fracture. It usually stays on for about 6 weeks.
Malnutrition, specifically vitamin-D deficiency, increases the risk of greenstick fractures of the long bones after a trauma.
Special note
Health care providers are trained to recognize injuries like this one in young children as a sign of possible abuse. They may ask questions about how your child was injured. Health care providers are required by law to ask you these questions. This is done for the child's protection. Please try to be patient and don't get upset.
Home care
Medicines
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The provider may prescribe medicines for pain and swelling. Or your child may use over-the-counter medicine as directed by the provider. Follow the provider’s instructions when giving these medicines to your child.
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Always talk with your child's provider before giving these medicines if your child has chronic liver or kidney disease, or ever had a stomach ulcer or gastrointestinal bleeding.
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Don’t use ibuprofen in children younger than 6 months old.
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Don’t give your child aspirin. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder that most often affects the brain and the liver.
General care
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Your child will be given a splint or cast to keep the injured area from moving. Keep your child’s arm raised to reduce pain and swelling. When sitting or lying down, raise the arm above heart level. You can do this by placing the arm on a pillow that rests on the chest. Or you can place the arm on a pillow at your child’s side. This is most important during the first 48 hours after injury.
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Apply an ice pack over the injured area for 20 minutes. Do this every 1 to 2 hours the first day. Keep using ice packs 3 to 4 times a day for the next 2 days. Then use an ice pack as needed to ease pain and swelling.
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To make an ice pack, put ice cubes into a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice directly on the skin. As the ice melts, be careful that the cast or splint doesn’t get wet. You can place the ice pack inside the sling and directly over the splint or cast.
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Keep the cast or splint dry at all times. Bathe with the cast or splint out of the water, protected with 2 large plastic bags. Place 1 bag outside of the other. Tape each bag with duct tape at the top end or use rubber bands. Younger children may be hurt when removing tape. For younger children, put a rubber band around each bag at the top end. Water can still leak in. So it's best to keep the cast or splint away from water. If a fiberglass splint or cast gets wet, dry it with a hair dryer on a cool setting. Do not set the dryer on a warm or hot setting as it may burn your child's skin. You can use a vacuum with a hose to pull air through the cast for quicker drying. If the cast remains wet, contact your health care provider because a wet cast can cause skin breakdown.
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Don't apply powder or lotion on, near, or inside the cast. Don't try to insert anything in your cast. This can injure your skin which may lead to infections. Don't pull out padding inside your cast.
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Your child should stay away from activities with a high risk of falling while they are healing. There is a high risk of refracture and complete fracture.
Follow-up care
Follow up with the health care provider in 1 week, or as advised. This is to be sure the bone is healing correctly and in correct alignment. If your child was given a splint, it may be changed to a cast at the follow-up visit. There is a chance that a greenstick fracture will move out of place again during the first week before the ends begin to seal together. So it is important that you follow up as directed for another X-ray.
If X-rays were taken, you will be told of any new findings that may affect your child’s care.
For some time, the forearm bones may be weaker due to immobilization in the cast. Your child should stay away from activities with a high risk of falling (especially in the school and playground), for 3 to 4 weeks after the cast is removed. This allows the bones to safely regain their normal strength.
Depending on the severity and complexity of your child's fracture, your health care provider may recommend physical therapy. Your physical therapist would suggest specific exercises for your child to:
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Make muscles stronger,
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Limit stiffness and regain range of movement.
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Restore functionality of the forearm.
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Prevent complications caused by tissue damage.
When to call your doctor
Contact your child's health care provider right away if:
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The cast or splint becomes loose.
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The cast or splint has a bad smell.
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The cast or splint has cracks or breaks.
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The plaster cast or splint becomes wet or soft.
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The fiberglass cast or splint stays wet for more than 24 hours.
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Your child has increased tightness, soreness, or pain under the cast or splint.
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Your child's fingers become swollen, cold, blue, numb, or tingly.
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