1. science
2. medicine
3. surgery

GREENSTICK
FRACTURE
WITH
DISLOCATION
DISPLACEMENT
OF
P.
The
notice
in
Case
1-A
purpose
the
of this
R.
paper
OF THE
UPPER
END
THE
RADIO-HUMERAL
OF
THE
WRIGHT,
SUPERIOR
an
boy
of
four
fracture
displacement
of
ofthe
fell
the
upper
elbow
Case
and
the
to
upper
his
right
end
of
ofthe
radius
of the ulna
Case 2-Greenstick
fracture
of the ulna
girl of
fracture
displacement
of the
NO.
injury
of childhood
which
has
received
little
4,
REPORTS
arm,
the
injuring
ulna
(Fig.
I).
his
with
The
elbow.
Radiographs
extension
fracture
showed
deformity,
was
reduced
and
a
forward
by manipulation
in plaster-of-Paris
a full, painless
range
for five weeks.
of movement
of
forearm.
fracture
45 B,
EPIPHYSIS
ENGLAND
and the arm was immobilised
of the plaster
he had regained
1-Greenstick
Case
2-A
greenstick
VOL.
on
end
under
general
anaesthesia
Two weeks
after removal
the
ULNA
OR
literature.
CASE
greenstick
THE
JOINT
RADIAL
MARGATE,
is to describe
OF
with extension
deformity
the upper end of the radius.
F...
2
with extension
deformity
the upper end of the radius.
two fell from
of the upper
upper
NOVEMBER
end
1963
a chair,
end of
of the
radius
injuring
the ulna
(Fig.
and
forward
displacement
of
and
forward
displacement
of
her left elbow.
with
extension
2).
Manipulative
Radiographs
deformity,
reduction
and
was
showed
forward
a
performed
727
P.
728
under
general
anaesthesia,
Immobilisation
plaster
in plaster
the
Case
child
3-A
boy
of
of
pain
complained
upper
of
end
the
was
of
the
radius
and
ulnar
but
pronation
4-A
plaster
valgus.
This
normal
but
after
and
3-Greenstick
girl
of
without
showed
after
deformity
boy
removal
of the
plaster
is shown
extension
the
ulnar
nerve
forearm
the
superior
an
injury
to his
upper
radial
left
ofthe
Recovery
right
valgus
elbow.
deformity
reduction
and
of
the
immobilisation
it became
clear
about
1 5 degrees
of cubitus
the
elbow
rapidly
four
radio-ulnar
and
was
joint
performed
fixed
elbow,
had
the
upper
end
in view
There
of movement
JOURNAL
the
but
(Fig.
of which
ulna
was
with
also
6).
were
valgus
separation
manipulation
under
The position
on
of the
OF
place
details
was by
in plaster.
of
full,
of supination.
taken
ofthe
5),
(Fig.
Eighteen
almost
at 45 degrees
joint
to
months
supination.
remained
that
returned
radiographs
epiphysis.
THE
her
with
plaster
epicondyle.
Treatment
weeks’
immobilisation
7.
side).
was
extension
being
regained,
the
radio-ulnar
fracture
of the
in Figure
and
injured
Open
superior
pronation
flexion
a greenstick
humeral
by three
the
of
After
rapidly
on the other
fracture,
Further
range
was
of the
displace-
ulna
4).
of
limited.
involved
the
of
of
there
arm
diagnosis
reduction
was
and
ulnar
end
the
immobilisation.
lateral
the
upper
and
correct
90 degrees
of the
(Fig.
that
and
of
absent,
school
end
removal
and
injury
sustained
of the medial
followed
weeks’
He
of
the
Open
supination
and
school.
at
fracture
of
the
with
ofthe
remained
after
at
upper
On
fracture
fusion
and
epiphysis
decreasing
showed
steps
Flexion
ulnar
were
that
a fracture-separation
epiphysis
anaesthesia
incomplete
tralispOsition
of thirteen
of the
general
weeks.
was
months
pronation
Radiographs
and
the
by four
manipulation
three
supination
anterior
suggested
of
radial
with
accepted.
and
Thirty
and
5-A
unknown.
was
later
of the
forearm.
recognised
success.
compared
of the
and
training
first
FIG. 3
of the ulna with varus deformity
of the upper end of the radius.
upper
a gradually
injury
Radiographs
Case
for
fracture
that
explained
valgus.
supination
ulnar
days
without
followed
(70 degrees
at
accepted.
removal
elbow
displacement
Eight
was
after
a greenstick
not
extension
a flight
the
physical
lateral
was
but
and
fracture
together
maintained
and
injury
offiexion,
down
of
out,
doing
position
weeks
of the
showed
attempted
limited
fell
while
this
the
Two
movement
radiographs
out,
range
a greenstick
position
months
carried
incomplete
weeks.
manipulation.
was
fracture
ment
ten
arm
deformity
slightly
pronation
cubitus
and
of
therefore
carried
injury
this
right
varus
remained
was
his
elbow,
was
three
of painless
extent
a full
of the
range
The
removed
Case
was
a full
reduction
fracture-separation
reduction
for
with
3).
showed
epiphysis
reduction
injured
ulna
was
was
Radiographs
and
although
maintained
in plaster
fracture
plaster
and
in the
manipulative
the
Case
six
WRIGHT
was
regained
(Fig.
immobilised
made
ill
had
R.
BONE
elbow
AND
and
JOINT
forearm
SURGERY
GREENSTICK
FRACTURE
OF THE UPPER
FIG.
Case
4-Greenstick
fracture
separation
of
the
and
involvement
4-Radiographs
taken
thirty
superior
VOL.
45 B,
NO.
4,
NOVEMBER
1963
valgus
radial
deformity
and
fracture-
epiphysis.
5
reduction,
radio-ulnar
FIG.
Case
with
of the upper
after attempted
of the superior
729
4
ulna
FIG.
Case 4-Radiographs
END OF THE ULNA
showing
incomplete
reduction
joint by the ulnar fracture.
6
months
radio-ulnar
after
injury
joint.
suggesting
fusion
of
the
730
P.
was
slow
loss
of flexion.
time
it became
of the
united
and
four
months
after
Pronation
clear
injury
was
that
there
limited
traumatic
Case
WRIGHT
was
still
30 degrees
to 20 degrees
ulnar
ulnar
nerve
was performed.
and that involvement
of the
R.
neuritis
Further
superior
and
was
of extension
and
showed
joint had
after
and
40 degrees
to 70 degrees.
developing
radiographs
radio-ulnar
5-Radiographs
loss
supination
anterior
that
not
At
this
transposition
the ulnar
occurred
fracture
(Fig. 8).
had
reduction.
I
rr.,
_#
,.
L.’
I
Case
5-Radiographs
showing
union
of the superior
of the ulnar
radio-ulnar
fracture
joint.
without
involvement
DISCUSSION
Hume
(1957)
described
three
associated
showed
with anterior
dislocation
that in one of the cases
fracture
and
the head
in Case 3 above.
Beddow
and
fracture
of
dislocation
The
of the
literature
It
seems
the
clear
ofthe
was displaced
(1960)
the
radio-humeral
joint.
does not contain
any
other
matter
what
laterally,
two
with
no
of
described
ulna
that,
end
of undisplaced
fracture
of the
of the head
of the radius.
there
was a varus
deformity
radius
Corkery
upper
cases
the
cases
varus
reports
direction
similar
of the
in children
to the displacement
same
deformity
of this
olecranon
The radiographs
in his paper
of the ulna at the site of the
type,
was
in which
described
a greenstick
accompanied
by
lateral
injury.
of angulation
of the
ulna
may
ulna and the radius
remain
in a fixed relationship
to one another
while
the injury
place.
Only in this way can the correspondence
between
the direction
of angulation
ulna and the direction
of displacement
of the upper
end of the radius
be explained.
be,
the
is taking
of the
For the
same reason
it seems clear that this position
must be one of full supination.
The most probable
mechanism
therefore
seems to be a fall on to the outstretched
hand during
which
the forearm
is held supinated
(as it might be ifthe child were falling
backwards).
The direction
of angulation
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
GREENSTICK
of the
ulna
varus,
valgus
will
then
or
by
be determined
hyperextension
(1957)
Hume
explained
FRACTURE
OF
by the
strain
suggested
that
on
UPPER
exact
the
anterior
a hyperextension
THE
direction
forearm
on
the
more
group,
likely
in which
ing
the
the
injury
the direction
the
that
arm
dur-
the
same,
but
is determined
of the
failure
of the
to
injury
Even
when
ment
of the ulna
may
the
radius
is in
the
produce
a
while
the
head
the
radius
by Evans
however,
of
(1949)
could
might
be
position
of
in the production
of the
not apply to those cases
may
the
true
it is first
the
not
(Cases
which
by
reduction
recognise
when
may
fall,
fall.
it is recognised,
manipulation
731
ULNA
a
ofthe
Imperfect
from
form
position
Complications-l)
by
types
is essentially
direction
nature
three
ofangulation
exact
result
all
THE
9).
of
ulna
OF
of the
(Fig.
displacement
strain
pronation-a
mechanism
similar
to that described
Monteggia
fracture-dislocation.
Such an explanation,
with medial
and lateral
displacement.
It
seems
END
displace-
be easy
2 and
seen.
to correct
4).
2) Trau-
matic ulnar neuritis
is a considerable
danger
in those
cases
with
valgus
deformity
if
reduction
is imperfect.
injury
was not seen
occurred
of the
in one
displacement
of the
by
and
Beddow
3)
this
in
Radial
series
patients
radial
with
head
Corkery
the
(1960).
They
it to be a neurapraxia
traction
by
the displaced
radial
nerve
supinator
as
muscle.
through
must
to the
occur
to have
the
involved
only
ulnar
1’
GREENSTICK
superior
in all cases
loss of movement
case,
in which
the
appeared
resulting
radius
on
it winds
4) Injury
radio-ulnarjoint
complete
in one
lateral
described
considered
from
nerve
but it
FRACTURE
ULNA WITH VARUS
but
OF
MONTEGGIA
AND LATERAL
DISPLACEMENT
OF RADIAL HEAD
occurred
fracture
F
To
illustrate
the
the joint.
INJURY
DEFORMITY
9
of
mechanism
Monteggia
this
injury
and
the
injury.
SUMMARY
1.
Five
cases
of greenstick
radio-humeral
joint
Although
of the upper
the
end
2.
cases
form
3.
The
of
the
upper
end
of the
ulna
with
dislocation
of
the
are described.
direction
of angulation
of the fracture
and the
of the radius
may be lateral,
medial
or anterior,
a group
is considered
fracture
to be
in which
the
mechanism
ofinjury
a fall
the
outstretched
hand
complications
on
of the
I should
like
and
CORKERY,
injury
to thank
Mr
are
W.
is essentially
with
the
corresponding
it is suggested
the
forearm
same.
held
displacement
that all five
This
mechanism
in supination.
described.
A.
Watt
Maney
for
permission
to include
Case
5.
REFERENCES
F.
BEDDOW,
H.,
Fracture
EVANS,
HUME,
VOL.
E.
of the Upper
M.
(1949):
C. (1957):
of the Olecranon
A.
45 B,
NO.
4,
End
Pronation
(1960):
of the Ulna.
P. H.
Injuries
Anterior
Dislocation
in Children.
Journal
NOVEMBER
1963
of the
Lateral
Dislocation
Journal
of Bone
Forearm.
of the Head
of Bone
and
of the Radio-humeral
and
Journal
of the
Joint
Joint
ofBone
Radius
Surgery,
Surgery,
andJoint
Associated
39-B, 508.
Joint
42-B,
with
Greenstick
782.
Surgerv,
with
31-B,
Undisplaced
578.
Fracture