View source for Toddler's fracture

==Background==
*Also known as Childhood Accidental Spiral Tibial (CAST) fracture
*Nondisplaced (or minimally displaced) spiral fracture of the tibia
*Typically encountered in ambulating toddlers (9 months - 3 years) due to low energy trauma with rotational component (i.e. twisting body while one leg is planted).
*NOT generally associated with non-accidental trauma.

==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

==Differential Diagnosis==
{{Tibial fractures peds}}

==Evaluation==
[[File:Tibfracture.png|thumb|A toddler's fracture]]
*X-ray of affected limb
**May only present as faint oblique line on AP view
**May need oblique view if strong suspicion but AP/lat are negative

==Management==
{{General Fracture Management}}

===Specific Management===
*CAM walker boot can be used as alternative to casting strategies<ref>Toddler's Fracture - CAM Walker Boot, Cast, or Nothing? https://journalfeed.org/article-a-day/2020/toddlers-fracture-cam-walker-boot-cast-or-nothing</ref> <ref>Management of Toddler's Fractures: A Systematic Review.  Pediatr Emerg Care. 2020 Jan 20. doi: 10.1097/PEC.0000000000002005. https://www.ncbi.nlm.nih.gov/pubmed/31977777?dopt=AbstractPlus</ref>. 
*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). 
*Negative x-ray with high suspicion for occult fracture
**Immobilize and follow up with ortho for bone scan or repeat x-ray in 1 week

==Disposition==
*Discharge with ortho follow-up

==See Also==
*[[Tibia fracture (peds)]]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:Orthopedics]]