Toddler's fracture: Difference between revisions

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==Background==
==Background==
*Isolated spiral fx of distal tibia in a toddler
*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==
*Child limping or refusing to bear wt
*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
*Usually pain with palpation and rotation of distal tibia
*Swelling may be minimal or absent
*Swelling may be minimal or absent
==Diagnosis==
*May need oblique view if strong suspicion but AP/lat are negative


==Treatment==
==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==
{{Tibial fractures peds}}
 
==Management==
*Definite fracture
*Definite fracture
**Immobilize in long leg splint
**Immobilize in long leg splint (knee flexed to provide rotational control and prevent weight bearing)
**Ortho f/u next day for definitive casting
**Ortho follow up next day for definitive casting. Usually takes 3-4 weeks for healing without further intervention.
*High suspicion despite negative x-ray
**Serial radiographs to monitor for developing deformity (ie leg length discrepancy or varus/valgus angular deformity).
**Immobilize and f/u w/ bone scan or repeat x-ray in 1wk
*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


==See Also==
==See Also==
*[[Fractures (Main)]]
*[[Tibia fracture (peds)]]


==Source==
==References==
Tintinalli
<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:Ortho]]
[[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

See Also

References