Toddler's fracture


  • 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

Differential Diagnosis

Pediatric Tibial Fractures


A toddler's fracture
  • 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


General Fracture Management

Specific Management

  • CAM walker boot can be used as alternative to casting strategies[1] [2].
  • 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


  • Discharge with ortho follow-up

See Also


  1. Toddler's Fracture - CAM Walker Boot, Cast, or Nothing?
  2. Management of Toddler's Fractures: A Systematic Review. Pediatr Emerg Care. 2020 Jan 20. doi: 10.1097/PEC.0000000000002005.