FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

DAUGHTER'S "GREENSTICK" FRACTURE BEING TREATED CORRECTLY

Question: Our daughter was rollerblading last week and had a fall. She hurt her shoulder, so we took her to the emergency room. The doctor thought she might have broken her collarbone, but in the X-ray it only appeared to be bent over. Obviously, there is a difference between her injury and a broken collarbone because he just put her arm in a sling that she is to use until it feels better. What is that difference?

Answer: I've learned that talking is easy but that actually communicating when we talk can be quite difficult. I'll give you an example: A patient of mine went to the emergency department to have an injury to his lower arm treated. When he came to see me the next day he said, "Thank goodness I only broke my arm -- it could have been fractured!" That doctor talked to my patient without communicating very well. You see, we doctors use "fracture" as the "doctor term" to describe a broken bone. Consequently, any broken bone can also be described as being a fracture. The two terms have precisely the same meaning.

Without seeing your daughter's X-rays, I can't tell you the correct "doctor language" to describe her injury. You see, there are two similar types of bone injury -- fractures, if you will -- that could be described as "bent over." First, you need to think of a long bone like the collarbone or those of the arms and legs as being similar to a straw. The bone is made of a hard outside with soft porous bone on the inside. One type of "bent over" fracture involves enough force to cause one side of the bone to fail while the other just bends. This is like the kink that occurs in a straw when it is bent over the side of a cup. The outside of the bend is rather smooth while the inside has a definite kink in it. Doctors call this type of injury a "greenstick" fracture, and it is probably what your daughter has. A related type of injury is called a "torus" or "buckle" fracture. In these fractures, the injuring force is directly along the length of the bone. The bone buckles under this force instead of shattering. This is similar to the type of deformity created in a straw when you pop off its paper wrapper by holding the straw firmly and slamming its end straight down on the table at your favorite fast food restaurant. The straw often develops a subtle ring-like bulge below where your had held it. You've just made a torus fracture of the straw.

Both torus and greenstick fracture are most common in children because their bones have a bit of "give" or flexibility to them. The bones in those of us who have finished growing are more brittle. They tend to break rather than to bend.

The collarbone, like any other bone, hurts a great deal when it is broken. The treatment of the fracture usually involves placing the ends of the bone in correct alignment and limiting the movement there. This reduces the pain and facilitates healing. The collarbone is an important part of the shoulder, but its exact shape isn't that important. Therefore, it usually isn't necessary to "set" it and apply a cast as is necessary for fractures of many long bones.

In either a greenstick or torus fracture the degree of bending and/or bulking at the site of injury is small, so it doesn't need to be set. Consequently, it only requires some stabilization to reduce the pain and allow the bone to heal properly. In a collarbone fracture in children this is usually done by wearing a simple arm sling for a week or two, just as the doctor recommended for your daughter. There are other types of fractures to the collarbone, however. In rare cases, these can even be sufficiently serious that prompt surgery is necessary to pin the pieces back together. Fortunately, your daughter's injury is the more common and more easily treated kind.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.