Toddlers fracture

• Toddler fracture:

  • Also called childhood accidental spiral tibial (CAST) fractures
  • Minimally displaced or un-displaced spiral fractures usually of the distal tibia
  • Can be a fracture of other lower limb bones - does not include spiral femoral fracture, which should raise suspicion of non-accidental injury
  • Typically occur between ages of 9 months and 3 years
• Mechanism:

  • Often caused by a twisting injury
  • Often from a simple fall or stumble
  • The specific event may not always be obvious
• Clinical presentation:

  • Often have vague symptoms not clearly related to the tibia
  • Non-specific pain
  • Inability to weight-bear
  • Localised tenderness
• Imaging:

  • Multiple view x-rays
  • Sometimes can be normal - follow up x-ray in 2 weeks if clinical suspicion
• Management:

  • Often heal well with simple management
  • Rest
  • Analgesia
  • Potentially a splint or cast for immobilisation