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Incomplete Fractures
KEY FACTS
Terminology
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Incomplete fracture: Macroscopic fracture line does not traverse entire bony diameter
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Pediatric bones more elastic than adult bones
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Greater propensity to bow or bend before breaking
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Buckle fracture: Focal outward bulge of cortex (without frank interruption) on compression side; cortex usually intact on tension side
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Plastic deformation: Smooth but accentuated bending of shaft without visible fracture line
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Greenstick fracture: Discrete fracture line on tension side does not extend through opposite cortex
Imaging
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2 tangential views show at least 1 unbroken cortex
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Occurs in diaphysis or metadiaphysis
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Typically diagnosed & managed by radiographs alone
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Contralateral comparison views may be helpful
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Especially in plastic deformation
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Top Differential Diagnoses
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Bowing due to underlying skeletal disease
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Systemic or localized bony dysplasias
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Metabolic bone diseases
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Normal developmental variants
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Salter-Harris type II fracture
Clinical Issues
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Pain, swelling, tenderness, disuse of limb after fall
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Greenstick type refractures in 7-20%
Diagnostic Checklist
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Imaginary marble should smoothly roll down diaphyseal & metaphyseal cortex on radiograph: If it dips or bounces, strongly consider incomplete fracture
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Look carefully for metaphyseal fracture line extending to physis (implying Salter-Harris type II fracture): Complications & follow-up different from buckle
PA & lateral radiographs of the wrist in a 5 year old after a fall show a buckle deformity
of the distal radial metadiaphyseal junction as well as an incomplete fracture (with cortical interruption) of the distal ulna
.
of the distal radial metadiaphyseal junction as well as an incomplete fracture (with cortical interruption) of the distal ulna .
AP & lateral radiographs of the forearm in a 5 year old after a fall show incomplete fractures of the distal radial & ulnar diaphyses. Note the intact “bent but not broken” posterior cortex of each bone
, typical of greenstick fractures.
, typical of greenstick fractures.
AP radiograph of the forearm in a 5 year old after a fall shows a plastic (bowing) deformity of the ulnar diaphysis
. The radial curvature is within normal limits. The ulnar deformity is not readily visible on the lateral view.
. The radial curvature is within normal limits. The ulnar deformity is not readily visible on the lateral view.
Axial T2 FS MR in the same patient 4 days later (performed for specific elbow complaints) shows marrow
, periosteal
, & soft tissue edema in/about the ulnar diaphysis with no cortical break. Subperiosteal hemorrhage
is noted. The radius
is normal.
, periosteal , & soft tissue edema in/about the ulnar diaphysis with no cortical break. Subperiosteal hemorrhage is noted. The radius is normal.
TERMINOLOGY
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