The Toddler's Fracture

Abstract

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.

Splinting of Low-Risk Pediatric Fractures

“…37 Some studies have even suggested no immobilization, given the stability of these injuires. 38 While it would be reasonable to immobilize these in a long-leg splint or cast, neither leads to improved outcomes and is associated with increased orthopedic visits and health care costs. 39 Nondisplaced fractures of the midshaft of the tibia are amenable to a posterior long-leg splint with non-weight-bearing instructions and referred for urgent orthopedic outpatient follow-up.…”

“…These injuries are safe for immobilization in a CAM (controlled ankle movement) walking boot and outpatient orthopedic follow-up 37 . Some studies have even suggested no immobilization, given the stability of these injuires 38 . While it would be reasonable to immobilize these in a long-leg splint or cast, neither leads to improved outcomes and is associated with increased orthopedic visits and health care costs 39 .…”

Reducing Rigid Immobilization for Toddler’s Fractures: A Quality Improvement Initiative

“…1 Due to its inherent stability, there is little risk of displacement during the healing process. 2 In cases of a negative radiograph, any toddler with a limp and suspicion for a lower-leg fracture is treated similarly as a presumed toddler's fracture. 3 Various treatment options are available, 4 including immobilization with a cast or splint, with a walking boot or brace, or without immobilization.…”

“… 1 Due to its inherent stability, there is little risk of displacement during the healing process. 2 In cases of a negative radiograph, any toddler with a limp and suspicion for a lower-leg fracture is treated similarly as a presumed toddler’s fracture. 3 …”

Correlation of temperament characteristics and early functional exercise compliance in school-age children with limb fractures: Implication for clinical nursing care

“…[ 1 , 2 ] Children’s psychological and behavioral development is more mature than that in early childhood, but their experience in life, self-protection ability, concentration and self-control are still not strong. [ 3 ] When children enter school life at this stage, their parents’ awareness of protection is more relaxed than before, and school-age children’s self-safety awareness is not strong, making the school-age children prone to upper or lower limb fractures. [ 4 , 5 ] In addition to correct treatment after fracture, the functional exercise of the affected limb after treatment is very important.…”