TODDLER'S FRACTURE
(Pediatric Broken Leg)
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What is a Toddler's Fracture?
A toddler fracture is a type of broken leg in young children, typically kids less than 3 years old.
A toddler fracture is a spiral break in the tibia (the shin bone in your leg), which occurs after a child twists their leg during a fall. Its a very low energy break, and usually its a hairline crack without significant damage to the bone or surrounding tissue.
Diagnosing a Toddler's Fracture:
A toddler fracture is suspected when parents brings their child to the doctor after a minor fall, or after no apparent accident, and the child is limping or unable to put any weight on their leg. The injured leg is rarely significantly swollen but its classically tender and especially sensitive to any rotation, like turning to foot outward, because this recreates the same rotational force that caused the initial crack.
Doctors that are suspicious for this injury will order x-rays of the leg.
X-rays will diagnose the injury, and a hairline can crack can be seen in the tibia bone.
X-rays are also useful to measure the bone alignment and to make sure the break didn't cause the bone to shorten more than 1 cm, or bend more than 10 degrees. But remember that in the vast majority of case the crack is very small and the bone remains perfectly aligned. In fact, sometimes the x-rays won't show any crack, but doctors with a high suspicion for a this injury will still treat it as a break once they rule out other causes for a limp. In such cases without an obvious crack on x-ray, follow up x-rays 2 weeks later will show signs of bone healing, indicating that there was a true break, just too small to be seen on x-ray.
Treating a Toddler's Fracture:
These injuries almost always heal very well after being casted to protect the bone while it heals.
Doctors will put on a cast from the toes, past the knee, all the way to the mid-thigh. They often also bend the knee slightly so that kids can't walk excessively on the injured leg while its this cast (although recent studies have shown no increased risk of bone displacement or delayed healing when kids are allowed walk on their broken leg within the cast).
X-rays are repeated 2 weeks after the injury to ensure there are signs of healing.
The cast can removed around 4-6 weeks, as long as the tibia bone is no longer tender. It typically takes a 10 weeks for the bone to heal completely, however once there is no pain over the break, and x-rays show signs of healing, there is low risk for re-injury or displacement at the fracture site, so kids can begin walking again as much as they can tolerate.
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Reference
1) Silva et al. A comparison of two approaches for the closed treatment of low energy tibial shaft fractures in children. JBJS 2012; 94: 1853-60. full article.
2) Jenkins DM et al. Early weight bearing after complete tibial shaft fractures in children. JPO 2009; 18: 241-6. full article.
3) Tenenbien M. The toddler's fracture revisited. Am J Emerg Med. 1990, 8: 208-11. full article.
4) Mashru RP. Tibial shaft fractures in children and Adolescents. JAAOS 2005; 13: 354-52. full article.