Toddler's fracture: Difference between revisions
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*May need oblique view if strong suspicion but AP/lat are negative | *May need oblique view if strong suspicion but AP/lat are negative | ||
==Differential Diagnosis== | |||
{{Tibial fractures peds}} | {{Tibial fractures peds}} | ||
Revision as of 07:15, 10 January 2015
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 pts <5yr after twisting foot while planted on same leg
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
Diagnosis
- 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 f/u 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 f/u w/ bone scan or repeat x-ray in 1wk
See Also
Source
Tintinalli