Toddler Fracture

Aka: Toddler Fracture, Toddlers Fracture, Toddler's Fracture, Tibial Shaft Fracture in Children, Spiral Fracture of Tibial Shaft

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II. Definitions

  1. Toddler Fracture
    1. Distal tibia spiral Fracture in ambulatory children under age 3 years

III. Epidemiology

  1. Most common Fracture in age 9 months to 3 years that present with a limp (29%)
  2. Not suspicious for abuse (contrast with other spiral Fractures)

IV. Symptoms

  1. Limping Child
  2. Low mechanism injury
    1. Typically child Running, falls, and is then non-ambulatory or with painful ambulation
    2. Typically follows minimal or unwitnessed Trauma

V. Signs: Provocative maneuvers

  1. Tenderness to palpation over the mid to distal tibia
  2. Passive dorsiflexion of ipsilateral foot
  3. Tibia twisting by rotating foot while holding knee stable
    1. Observe child for crying or wincing with maneuver

VI. Differential Diagnosis

  1. Nonaccidental Trauma (e.g. non-ambulatory children, age <9 months)
  2. See Pediatric Limp

VII. Imaging: Ankle XRay

  1. Spiral Fracture of distal tibia (best seen on internal oblique view)
    1. May be occult Fracture (normal initial xray in 40% of cases)
    2. Repeat XRay in 7-10 days

VIII. Management

  1. Orthopedic referral
  2. Displaced Fracture Management
    1. Posterior long leg splint for 5-7 days, THEN
    2. Long leg cast
      1. Some recommend below knee walking cast for 3 weeks
  3. Non-displaced Fracture management is controversial
    1. Short leg posterior splint OR
    2. Bulky dressing OR
    3. Observation

IX. References

  1. (2018) Crit Dec Emerg Med 37(5): 3-14
  2. Latessa (2012) AAFP Board Review Express, San Jose
  3. Claudius, Sacchetti and Seidan (2024) EM:Rap, Pediatric Pearls, accessed 2/1/2024

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