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Toddler's fracture
From WikEM
Contents
Background
- Subset of childhood accidental spiral tibial (CAST) fractures, where it is a minimally displaced distal spiral tibial fracture typically encountered in ambulating toddlers (9 months - 3 years) due to low energy trauma with rotational component.
- Also known as childhood accidental spiral tibial fracture
- Occurs in patients <5yr after twisting foot while planted on same leg
Clinical Features
- History of an otherwise healthy child, who was ambulating, falls and is then non-ambulatory or has painful ambulation.
- Usually pain with palpation and rotation of distal tibia
- Swelling may be minimal or absent
Evaluation
- May only present as faint oblique line on AP view
- May need oblique view if strong suspicion but AP/lat are negative
Differential Diagnosis
Pediatric Tibial Fractures
- Toddler's fracture
- Tibial spine fracture
- Tibial tuberosity fracture
Management
- Definite fracture
- Immobilize in long leg splint (knee flexed to provide rotational control and prevent weight bearing)
- Ortho follow up next day for definitive casting. Usually takes 3-4 weeks for healing without further intervention.
- Serial radiographs to monitor for developing deformity (ie leg length discrepancy or varus/valgus angular deformity).
- High suspicion despite negative x-ray
- Immobilize and follow up with bone scan or repeat x-ray in 1wk
