Toddler's fracture

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

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

• Toddler's fracture
• Tibial spine fracture
• Tibial tuberosity fracture

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

• Tibia fracture (peds)

References

Tintinalli