Pathology
A toddler fracture is, not surprisingly, a common fracture of
toddlers and preschoolers. It occurs when the child is running or
steps on something on the floor and loses his footing. A sudden
twisting of the tibia (shin bone) causes a fracture in a spiral
pattern. These can be actually quite difficult to see on xray unless
or even if the angle of view is just right. A bone scan may be
needed to show the fracture. Eventually the fracture site will be
visible as healing begins and new bone is formed to repair the
fracture.
Symptoms are what one would expect: pain, refusal to walk, minor
swelling or warmth over the fracture, and pain when the site of the
fracture is pressed. A long-leg cast is applied to relieve the
symptoms. Healing is rapid, within 3 or 4 weeks.
In the example below, this fracture represents a
typical toddler's fracture described by Dunbar in 1964 as a
subtle, non-displaced oblique fracture of the distal tibia in
children, 9 months to 3 years of age. The child usually presents
with an acute onset of limp or refusal to bear weight on one leg. An
unsteady toddler may have fallen with a twist, or the child may have
gotten his/her foot caught and fallen, twisting it while trying to
free his/her foot. Many times the fall is unwitnessed and parents
are unsure of what happened. This inability to give a history may
prompt a clinician to suspect child abuse. Children at this age are
also unable or unwilling to give a history or localize pain.
Also, they are at times, uncooperative with a physical exam.
Clinical signs of a toddler's fracture can be subtle with
non-specific physical findings of local injury.
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