This uniquely pediatric fracture pattern usually happens in the metaphyseal region of bone following a compressive force.

This three year old girl fell on her outstretched left arm while playing at daycare. Caregivers noted that she cried immediately and was reluctant to use the hand and arm normally for the rest of the day. This xray was done 24 hours later when her symptoms failed to resolve.

Can you identify the radiologic abnormality? Would you expect this fracture to be intrinsically stable or unstable?

The greenstick fracture pattern is similar to the pattern of structural failure seen when bending an immature tree branch.

This four year old boy fell off his bicycle while learning how to ride independently. He cried immediately and was brought to the hospital for assessment. The triage nurse noted an obvious deformity at the wrist. This xray was taken at the Emergency Room one hour after the injury.

The cortex on the tension aspect of the applied force breaks while the cortex on the compression side bends or is plastically deformed. What problems might this create during treatment?

In plastic deformation no fracture is visible but the anatomic shape of the bone has been altered due to microscopic failure and "memory" of the bone. This is similar to bending a wire coat hanger. Plastic deformation in older children may not remodel and requires either closed reduction or occasionally osteotomy (i.e. surgical cut of bone) to correct.

Angulated fracture of forearm with distal ulnar plastic deformation. The ulna is usually completely straight in AP and lateral xray views.