Toddler's fracture: Difference between revisions
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*Also known as childhood accidental spiral tibial fracture | *Also known as childhood accidental spiral tibial fracture | ||
*Occurs in patients <5yr after twisting foot while planted on same leg | *Occurs in patients <5yr after twisting foot while planted on same leg | ||
*Fracture is NOT associated with non-accidental trauma. | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 19:02, 19 August 2017
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
- Fracture is NOT 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
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
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