Do toddler’s fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?

Adamich, John; Camp, Mark

doi:10.1097/mej.0000000000000478

Cited by 17 publications

(33 citation statements)

References 15 publications

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“…None of the patients re-presented with fracture displacement, highlighting the benign prognosis of this injury regardless of treatment method 5 8 9. These data question the role of immobilisation for the purposes of fracture healing.…”

Section: Discussionmentioning

confidence: 89%

“…Therefore, treatment should be aimed at controlling pain while minimising the risk of social disruption and iatrogenic harm, such as skin complications. Recommendations for treatment of minor tibial fractures vary from full above knee casting,6 above or below knee casting,7 splint, controlled ankle motion boot to no immobilisation; however, the evidence base underpinning these recommendations is scant based on surveys and retrospective case series 8–10. Practice varies within and between institutions 10 11.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

2020

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ObjectiveTo compare the treatment practices (immobilisation vs non-immobilisation) of toddler fractures and other minor tibial fractures (both proven and suspected) in preschoolers, aged 9 months–4 years, and examine rates of ED re-presentations and complications.MethodsRetrospective chart review of presentations of minor tibial fractures, both proven (radiologically confirmed) or suspected (negative X-ray but clinical evidence of bony injury), in children aged 9 months–4 years presenting to a single tertiary level paediatric ED from May 2016 to April 2018. Data collected included treatment practices, subsequent unscheduled re-presentations (including reasons) and complications (defined as problems relating to the injury that required further active care).ResultsA search of medical records yielded 240 cases: 102 had proven fractures (spiral, buckle or Salter-Harris II) and 138 were diagnosed with a suspected fracture. 73.5% of proven fractures were immobilised, predominantly with backslabs. 79% of suspected fractures were treated with expectant observation without immobilisation. Patients treated with immobilisation were more likely to re-present to ED compared with non-immobilised patients (18/104, 17.3% vs 9/136, 6.6% RR 2.62, 95% CI 1.23 to 5.58). 21 complications were seen in 19/104 (18.3%) immobilised patients. There were eight skin complications (complication rate of 7.7%) and 11 cast issues (complication rate of 10.6%). Two (1.5%) of the 136 patients had complications related to pain or limp. Pain was uncommonly found, although follow-up was not universal.ConclusionIn our centre, proven minor tibial fractures were more likely to receive a backslab, whereas for suspected fractures, expectant observation without immobilisation was performed. Although there is potential bias in the identification of complications with immobilisation, the study suggests that non-immobilisation approach should be investigated.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

2020

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“…8 Twelve (6.5%) were not immobilized, and there were 13 (7.0%) unknown cases. 8 At the first clinical orthopedic follow-up visit, the type of immobilization changed for many of these patients. After this follow-up visit, the number of patients immobilized included 31 (16.8%) with BK splint, 24 (13.0%) with AK splint, 22 (12.0%) with BK cast, and 84 (45.7%) with AK cast.…”

Section: Duration Of Immobilizationmentioning

confidence: 98%

“…12 The most recent retrospective chart review, from SickKids hospital in Toronto, included 184 patients. 8 Initially, management varied in type of immobilization. Among those that were immobilized were as follows: 64 (34.8%) were with a BK splint, 67 (36.4%) with an AK splint, 9 (4.9%) with a BK cast, and 19 (10.3%) with AK cast.…”

Section: Duration Of Immobilizationmentioning

confidence: 99%

Management of Toddler's Fractures

Jeganathan

Elangainesan²,

Kam³

2020

Pediatr Emer Care

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The aim of this study was to examine and compare the efficacy of external fixation strategies of toddler's fracture (TF) in acute care settings. Specifically, we aim to identify whether immobilization optimizes clinical outcomes for patients (based on immobilization duration, time to weight-bear/ambulate, and associated complications) compared with nonimmobilization, with a systematic review.Study Design: After PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 2 independent reviewers searched electronic databases OVID Medline, Embase, and CINAHL for studies evaluating the health outcomes of various treatment methods for TF . The studies were chosen based on specific inclusion criteria. The 2 reviewers were looking for primary research articles that assessed health outcomes (such as immobilization duration, time to weight-bear/ambulate, and associated complications) of various treatment strategies for TF Fractures in acute care settings.Results: A total of 2385 articles were initially screened, reviewed, and then narrowed down to 6 studies for an in-depth analysis. Among these 6 studies, 5 were retrospective chart reviews and 1 was a cross-sectional online survey. A total of 565 patients from the retrospective chart reviews and 153 physicians from the cross-sectional online survey were further analyzed. The current evidence shows that there was no significant difference in clinical outcomes (ie, time to weight-bear and immobilization duration) between immobilization and nonimmobilization.Conclusions: Further large-scale prospective studies examining the clinical outcomes of TF management techniques should be conducted to establish a consistent standardized guideline for TF treatment across acute care settings.

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“…Atypical fractures, multiple fractures, other musculoskeletal injuries, and fracture in the setting of nonaccidental injury are all reasons that specialized care should be involved and arranged. 38…”

Section: Managementmentioning

confidence: 99%

The Toddler's Fracture

Wang

Doyle

Smit³

et al. 2021

Pediatr Emer Care

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Objective:The tibial toddler's fracture is an important diagnosis in both emergency and urgent care, presenting as acute onset lower extremity pain or limping in a young child. Diagnosis and management may be challenging because of an extensive differential diagnosis. The objectives of this study were to provide an overview of the toddler's fracture and to guide clinicians by summarizing up to date literature for both diagnosis and management this common condition.Methods: This study analyzed literature from the PubMed database from the years of 1964 to 2018. The main focus was on the diagnosis and management of the toddler's fracture.Results: This review demonstrates that diagnosis is primarily made through history and physical examination, as radiographs are often negative at initial presentation. Treatment involves a short period of immobilization, which can be facilitated through the use of a cast, a splint, or no external support. Successful healing and a full return to normal activities and development are near universal.Conclusions: Although a stable fracture with an excellent prognosis, opportunities exist to improve toddler's fractures diagnosis and treatment protocols, to optimize clinical management.

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Do toddler’s fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?

Cited by 17 publications

References 15 publications

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

Management of Toddler's Fractures

The Toddler's Fracture

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