WordNet

interrupt, break, or destroy; "fracture the balance of power"
breaking of hard tissue such as bone; "it was a nasty fracture"; "the break seems to have been caused by a fall" (同)break
fracture a bone of; "I broke my foot while playing hockey" (同)break
become fractured; "The tibia fractured from the blow of the iron pipe"
break (a bone); "She broke her clavicle"
break into pieces; "The pothole fractured a bolt on the axle"
violate or abuse; "This writer really fractures the language"
the act of cracking something (同)crack, cracking
a ring-shaped surface generated by rotating a circle around an axis that does not intersect the circle (同)toroid
commonly the lowest molding at the base of a column (同)tore

PrepTutorEJDIC

〈U〉(特に)骨を折ること;骨を折った状熊 / 〈C〉割れ(裂け)目,(鉱物の)破砕面 / 〈足・腕などを〉‘を'骨折する;…‘を'砕く / 骨折する;砕ける

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/23 21:35:43」(JST)

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Greenstick fractures on X-ray.

A buckle fracture of the distal radius.

A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Despite the name fracture, during the majority of cases the bone is broken and hard to find in x-rays. This is owing in large part to the thick fibrous periosteum of immature bone. A person's bones become harder (calcified) and more brittle with age and the periosteum becomes thinner and less restrictive. Greenstick fractures usually occur most often during infancy and childhood when bones are soft. The name is by analogy with green (i.e., fresh) wood which similarly breaks on the outside when bent. It was discovered by British-American orthopedist, John Insall, and Polish-American orthopedist, Michael Slupecki.

Classification of pediatric fractures

Pediatric fractures can be classified as complete and incomplete:^[1]

Incomplete: there are three basic forms of incomplete fractures:
- The first is the greenstick fracture, a transverse fracture of the cortex which extends into the midportion of the bone and becomes oriented along the longitudinal axis of the bone without disrupting the opposite cortex.
- The second form is a torus or buckling fracture, caused by impaction. They are usually the result of a force acting on the longitudinal axis of the bone: they are typically a consequence of a fall on an outstretched arm, so they mainly involve the distal radial metaphysis.^[2] The word torus is derived from the Latin word 'torus,' meaning swelling or protuberance.
- The third is a bow fracture in which the bone becomes curved along its longitudinal axis.^[3]
Complete fractures

There are also physeal fractures (fractures involving the physis, the growth plate, which is not present in adults). The Salter-Harris classification is the most used to describe these fractures.

Signs and symptoms

Some clinical features of a greenstick fracture are similar to those of a standard long bone fracture - greenstick fractures normally cause pain at the injured area. As these fractures are specifically a pediatric problem, an older child will be protective of the fractured part and babies may cry inconsolably. As per a standard fracture, the area may be swollen and either red or bruised. Greenstick fractures are stable fractures as a part of the bone remains intact and unbroken so this type of fracture normally causes a bend to the injured part, rather than a distinct deformity, which is problematic.

Pathogenesis and risk factors

The greenstick fracture pattern occurs as a result of bending forces. Activities with a high risk of falling are risk factors. Non-accidental injury more commonly causes spiral (twisting) fractures but a blow on the forearm or shin could cause a green stick fracture. The fracture usually occurs in children and teens because their bones are flexible, unlike adults whose more brittle bones usually break.

Treatment

Removable splints result in better outcomes to casting in children with torus fractures of the distal radius.^[4]^[5] Traditionally buckle fractures have been casted mostly below the elbow if it is in the wrist and small.^[5]

Fossil record

Evidence for greenstick fractures found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. Greenstick fractures (willow breaks) have been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis.^[6]

References

^ Yuranga Weerakkody. "Torus fracture". Radiopaedia.org. Retrieved 20 November 2014.
^ Yuranga Weerakkody. "Torus fracture". Radiopaedia.org. Retrieved 20 November 2014.
^ Jeremy Jones. "Bowing fracture". Radiopaedia.org. Retrieved 20 November 2014.
^ Firmin F, Crouch R (July 2009). "Splinting versus casting of "torus" fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): a literature review". Int Emerg Nurs 17 (3): 173–8. doi:10.1016/j.ienj.2009.03.006. PMID 19577205.
^ ^a ^b Abraham A, Handoll HH, Khan T (2008). "Interventions for treating wrist fractures in children". Cochrane Database Syst Rev (2): CD004576. doi:10.1002/14651858.CD004576.pub2. PMID 18425904.
^ Molnar, R. E., 2001, Theropod paleopathology: a literature survey: In: Mesozoic Vertebrate Life, edited by Tanke, D. H., and Carpenter, K., Indiana University Press, p. 337-363.

External links

Radiology Greenstick vs Torus Fractures

UpToDate Contents

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1. 小児における前腕遠位部骨折：初期マネージメント distal forearm fractures in children initial management
2. 小児における脛骨および腓骨骨幹部骨折 tibial and fibular shaft fractures in children
3. 小児における前腕骨遠位端部：診断および評価 distal forearm fractures in children diagnosis and assessment
4. 骨折のマネージメントの一般原則：小児における骨折のパターンおよび種類 general principles of fracture management fracture patterns and description in children
5. 児童虐待の整形外科的側面 orthopedic aspects of child abuse

English Journal

Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis.

Jiang N1, Cao ZH, Ma YF, Lin Z, Yu B.
Pediatric emergency care.Pediatr Emerg Care.2015 Nov 6. [Epub ahead of print]
OBJECTIVES: Pediatric forearm torus fracture, a frequent reason for emergency department visits, can be immobilized by both rigid cast and nonrigid methods. However, controversy still exists regarding the optimal treatment of the disease. The aim of this study was to compare, in a systematic review,
PMID 26555307

Botulinum toxin in masticatory muscles of the adult rat induces bone loss at the condyle and alveolar regions of the mandible associated with a bone proliferation at a muscle enthesis.

Kün-Darbois JD1, Libouban H2, Chappard D3.
Bone.Bone.2015 Aug;77:75-82. doi: 10.1016/j.bone.2015.03.023. Epub 2015 Apr 7.
In man, botulinum toxin type A (BTX) is injected in masticatory muscles for several indications such as trismus, bruxism, or masseter hypertrophy. Bone changes in the mandible following BTX injections in adult animal have therefore became a subject of interest. The aim of this study was to analyze c
PMID 25857689

Japanese Journal

CT画像における上咽頭構造の対称性の検討

市村恵一
耳鼻と臨床 36(4), 700-705, 1990
上咽頭構造の対称性を220例の軸位断CT像から検討した. ローゼンミュラー窩, 耳管隆起, 耳管開口部など浅い構造は, 咽頭筋群, 副咽頭間隙, 後壁筋膜面などの深い構造に比べ対称率は低かつたものの, 80%以上の対称率を示した. 上咽頭の対称性の消失は悪性腫瘍などの病変を強く疑わせることが示唆された
NAID 130004403616

小児橈骨下端骨折

廣本雅之,津嶋秀史,高橋正人,日下部輝夫,内西兼一郎
日本臨床外科医学会雑誌 49(11), 2211-2214, 1988
小児の骨膜下骨折は,若木骨折と隆起骨折に分けられるが,初診時のX線所見からの両者の鑑別は難しい.今回,当院の最近5年間における小児橈骨下端骨折76例を用い,仮骨の推移から両者を検討した.まず初診時のX線所見から, I型:骨の連続性がよく保たれ骨折部の変形が極めてわずかなもの, II型:連続性は保たれるが変形の軽度にみられるもの, III型:いわゆる完全骨折とした.さらに,受傷後4週間で,仮骨がほと …
NAID 130003596725

「小児骨折」

　　[★]

関: 骨折

小児は成人に比べ骨折の頻度が高い。
骨膜は厚く骨形成が旺盛、骨癒合が早い、骨膜が厚いために不完全骨折となることが多い(若木骨折)、自家矯正能が高い(屈曲変形は5歳までは30°、8歳までは20°の屈曲があっても完全に矯正されるが、回旋変形に対しては自家矯正力はほとんど働かない。長骨の短縮に対しても矯正能力があるが、過成長が長じやすい。骨幹端部の方が骨幹部よりも自家矯正能が高い)、靭帯損傷や脱臼はまれである(SOR.641改変)。
ほとんどの骨折では保存的治療でよい。
骨折のうち多いものは上腕骨顆上骨折である。この骨折では骨片が回旋転位するため手術を行う。