Toddler's fracture: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
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*Usually pain with palpation and rotation of distal tibia | *Usually pain with palpation and rotation of distal tibia | ||
*Swelling may be minimal or absent | *Swelling may be minimal or absent | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Tibial fractures peds}} | {{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== | ==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 | *Definite fracture | ||
**Immobilize in long leg splint (knee flexed to provide rotational control and prevent weight bearing) | **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. | **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). | **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 bone scan or repeat x-ray in | **Immobilize and follow up with ortho for bone scan or repeat x-ray in 1 week | ||
==Disposition== | |||
*Discharge with ortho follow-up | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 13:22, 24 March 2020
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
Pediatric Tibial Fractures
Evaluation
- 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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- CAM walker boot can be used as alternative to casting strategies[1] [2].
- 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
References
- ↑ Toddler's Fracture - CAM Walker Boot, Cast, or Nothing? https://journalfeed.org/article-a-day/2020/toddlers-fracture-cam-walker-boot-cast-or-nothing
- ↑ 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