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Toddler Fracture

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Toddler Fracture, Toddlers Fracture, Toddler's Fracture

  • See Also
  1. Pediatric Limp
  • Definition
  1. Toddler Fracture
    1. Distal tibia spiral Fracture in ambulatory children under age 3 years
  • 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)
  • Presentation
  1. Typically child Running, falls, and is then non-ambulatory or with painful ambulation
  2. Typically follows minimal or unwitnessed Trauma
  • Signs
  1. 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
  • Differential Diagnosis
  1. See Pediatric Limp
  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
  • Management
  1. Typical management
    1. Posterior long leg splint for 5-7 days, THEN
    2. Long leg cast
  2. Some recommend below knee walking cast for 3 weeks
  • References
  1. (2018) Crit Dec Emerg Med 37(5): 3-14
  2. Latessa (2012) AAFP Board Review Express, San Jose