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Incomplete Fractures
Emily S. Orscheln, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Buckle (torus), plastic (bowing), greenstick fractures
            • Definitions

              • Incomplete fracture: Macroscopic fracture line does not traverse entire bony diameter
              • Buckle fracture: Fracture on compression side
              • Greenstick fracture: Fracture on tension side
                • Named for appearance of bent immature tree branch ("green stick")
              • Plastic deformity: Smooth, abnormal bending of diaphysis without visible fracture line

            IMAGING

            • General Features

              • Radiographic Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Laor T et al: Describing pediatric fractures in the era of ICD-10. Pediatr Radiol. 50(6):761-75, 2020
                                      2. Iles BW et al: Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. Pediatr Radiol. 49(3):358-64, 2019
                                      3. Handoll HH et al: Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 12:CD012470, 2018
                                      4. Forestier-Zhang L et al: Bone strength in children: understanding basic bone biomechanics. Arch Dis Child Educ Pract Ed. 101(1):2-7, 2016
                                      5. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                                      6. Kim E et al: Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system. J Shoulder Elbow Surg. 21(12):1644-50, 2012
                                      7. Pountos I et al: Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study. J Child Orthop. 4(4):321-6, 2010
                                      8. Schmuck T et al: Greenstick fractures of the middle third of the forearm. A prospective multi-centre study. Eur J Pediatr Surg. 20(5):316-20, 2010
                                      9. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                                      10. Bochang C et al: Are frequent radiographs necessary in the management of closed forearm fractures in children? J Child Orthop. 2(3):217-20, 2008
                                      11. Carson S et al: Pediatric upper extremity injuries. Pediatr Clin North Am. 53(1):41-67, v, 2006
                                      12. Sai S et al: Radial head dislocation with acute plastic bowing of the ulna. J Orthop Sci. 10(1):103-7, 2005
                                      13. Swischuk LE et al: Frequently missed fractures in children (value of comparative views). Emerg Radiol. 11(1):22-8, 2004
                                      14. Roach RT et al: Paediatric post-traumatic cortical defects of the distal radius. Pediatr Radiol. 32(5):333-9, 2002
                                      15. Proubasta IR et al: Entrapment of the median nerve in a greenstick forearm fracture. A case report and review of the literature. Bull Hosp Jt Dis. 58(4):220-3, 1999
                                      16. Miller JH et al: Scintigraphy in acute plastic bowing of the forearm. Radiology. 142(3):742, 1982
                                      17. Martin W 3rd et al: Acute plastic bowing fractures of the fibula. Radiology. 131(3):639-40, 1979
                                      18. Borden S 4th: Roentgen recognition of acute plastic bowing of the forearm in children. Am J Roentgenol Radium Ther Nucl Med. 125(3):524-30, 1975
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Buckle (torus), plastic (bowing), greenstick fractures
                                                • Definitions

                                                  • Incomplete fracture: Macroscopic fracture line does not traverse entire bony diameter
                                                  • Buckle fracture: Fracture on compression side
                                                  • Greenstick fracture: Fracture on tension side
                                                    • Named for appearance of bent immature tree branch ("green stick")
                                                  • Plastic deformity: Smooth, abnormal bending of diaphysis without visible fracture line

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Laor T et al: Describing pediatric fractures in the era of ICD-10. Pediatr Radiol. 50(6):761-75, 2020
                                                                          2. Iles BW et al: Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. Pediatr Radiol. 49(3):358-64, 2019
                                                                          3. Handoll HH et al: Interventions for treating wrist fractures in children. Cochrane Database Syst Rev. 12:CD012470, 2018
                                                                          4. Forestier-Zhang L et al: Bone strength in children: understanding basic bone biomechanics. Arch Dis Child Educ Pract Ed. 101(1):2-7, 2016
                                                                          5. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                                                                          6. Kim E et al: Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system. J Shoulder Elbow Surg. 21(12):1644-50, 2012
                                                                          7. Pountos I et al: Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study. J Child Orthop. 4(4):321-6, 2010
                                                                          8. Schmuck T et al: Greenstick fractures of the middle third of the forearm. A prospective multi-centre study. Eur J Pediatr Surg. 20(5):316-20, 2010
                                                                          9. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                                                                          10. Bochang C et al: Are frequent radiographs necessary in the management of closed forearm fractures in children? J Child Orthop. 2(3):217-20, 2008
                                                                          11. Carson S et al: Pediatric upper extremity injuries. Pediatr Clin North Am. 53(1):41-67, v, 2006
                                                                          12. Sai S et al: Radial head dislocation with acute plastic bowing of the ulna. J Orthop Sci. 10(1):103-7, 2005
                                                                          13. Swischuk LE et al: Frequently missed fractures in children (value of comparative views). Emerg Radiol. 11(1):22-8, 2004
                                                                          14. Roach RT et al: Paediatric post-traumatic cortical defects of the distal radius. Pediatr Radiol. 32(5):333-9, 2002
                                                                          15. Proubasta IR et al: Entrapment of the median nerve in a greenstick forearm fracture. A case report and review of the literature. Bull Hosp Jt Dis. 58(4):220-3, 1999
                                                                          16. Miller JH et al: Scintigraphy in acute plastic bowing of the forearm. Radiology. 142(3):742, 1982
                                                                          17. Martin W 3rd et al: Acute plastic bowing fractures of the fibula. Radiology. 131(3):639-40, 1979
                                                                          18. Borden S 4th: Roentgen recognition of acute plastic bowing of the forearm in children. Am J Roentgenol Radium Ther Nucl Med. 125(3):524-30, 1975