- 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.
- 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
- 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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
- CAM walker boot can be used as alternative to casting strategies .
- 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
- Toddler's Fracture - CAM Walker Boot, Cast, or Nothing? https://journalfeed.org/article-a-day/2020/toddlers-fracture-cam-walker-boot-cast-or-nothing
- Management of Toddler's Fractures: A Systematic Review. Pediatr Emerg Care. 2020 Jan 20. doi: 10.1097/PEC.0000000000002005. https://www.ncbi.nlm.nih.gov/pubmed/31977777?dopt=AbstractPlus