Toddler fracture

A toddler fracture is a minimally displaced or undisplaced spiral fracture, usually of the tibia, typically encountered in toddlers.

It is a potentially difficult diagnosis to establish on account of both the symptoms and imaging findings being subtle

The term has sometimes also been used to describe occult fractures of other lower limb bones in the same age group (e.g. fibula, cuboid, calcaneum)

Epidemiology

• Usually of tibia
• Typically toddlers, age 9/12 to 3yrs
• Majority of cases are not suspicious/NAI
  • Although early reports  suggested that tibial toddler fractures were indicative of non-accidental injury, subsequent work has suggested that this is not the case and that the vast majority are not suspicious
  • As such they should not raise the alarm when present in isolation and the correct age group (i.e. ambulating toddlers)

Aetiology

• Thought to be result of new stresses placed on the bone due to recent & ↑’ing ambulation

Presentation

1. Vague symptoms, not clearly related to tibia
2. Refuse to weight bear
3. Irritable

Investigations

1. XR 
2. Toddler fractures are often radiographically normal on initial x-ray
3. if despite multiple views, no fracture can be identified, follow-up radiographs usually will demonstrate slight sclerosis and periosteal reaction

Treatment

1. Usually no treatment & spontaneously heal
2. Can apply backslab or above knee walking case for 4/52
3. Fracture clinic review in 2/52 with XR