Toddler's fracture: Difference between revisions
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==Background== | ==Background== | ||
* | *Also known as Childhood Accidental Spiral Tibial (CAST) fracture | ||
*Nondisplaced (or minimally displaced) spiral fracture of the tibia | |||
*Typically encountered in ambulating toddlers (9 months - 3 years) due to low energy trauma with rotational component (i.e. twisting body while one leg is planted). | |||
*NOT generally associated with non-accidental trauma. | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 9: | Line 10: | ||
*Swelling may be minimal or absent | *Swelling may be minimal or absent | ||
== | ==Evaluation== | ||
*May need oblique view if strong suspicion but AP/lat are negative | *X-ray of affected limb | ||
**May only present as faint oblique line on AP view | |||
**May need oblique view if strong suspicion but AP/lat are negative | |||
==Differential Diagnosis== | |||
{{Tibial fractures peds}} | |||
== | ==Management== | ||
*Definite fracture | *Definite fracture | ||
**Immobilize in long leg splint (knee flexed to provide rotational control and prevent weight bearing) | **Immobilize in long leg splint (knee flexed to provide rotational control and prevent weight bearing) | ||
**Ortho | **Ortho follow up 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). | **Serial radiographs to monitor for developing deformity (ie leg length discrepancy or varus/valgus angular deformity). | ||
* | *Negative x-ray with high suspicion for occult fracture | ||
**Immobilize and | **Immobilize and follow up with ortho for bone scan or repeat x-ray in 1 week | ||
==Disposition== | |||
*Discharge with ortho follow-up | |||
==See Also== | ==See Also== | ||
*[[ | *[[Tibia fracture (peds)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Revision as of 20:16, 19 August 2017
Background
- Also known as Childhood Accidental Spiral Tibial (CAST) fracture
- Nondisplaced (or minimally displaced) spiral fracture of the tibia
- Typically encountered in ambulating toddlers (9 months - 3 years) due to low energy trauma with rotational component (i.e. twisting body while one leg is planted).
- NOT generally associated with non-accidental trauma.
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
Evaluation
- X-ray of affected limb
- 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 follow up 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).
- Negative x-ray with high suspicion for occult fracture
- Immobilize and follow up with ortho for bone scan or repeat x-ray in 1 week
Disposition
- Discharge with ortho follow-up