Toddler’s Fracture

dok_zlo — 09.12.2023

A previously healthy 20-month-old boy was brought to the emergency department with a 2-hour history of pain and swelling in the left lower leg. The pain had started immediately after he had twisted his leg and fallen to the ground when pushed by his sibling. On physical examination, the child was crying and unable to bear weight on the left leg. The left lower leg was tender to palpation and painful with passive dorsiflexion of the ankle. Radiographs of the left lower leg showed a minimally displaced spiral fracture of the tibial shaft (Panel A, anteroposterior view; Panel B, lateral view; L denotes left). A diagnosis of a “toddler’s fracture” was made. Toddler’s fractures are a type of spiral fracture of the tibia that occurs in children between the ages of early walking and preschool. Such fractures result from low-energy twisting movements or falls. Toddler’s fractures are typically nondisplaced and thus radiographically subtle, unlike the fracture in this patient. Radiographically occult toddler’s fractures often become more visible on repeat radiographs obtained 1 to 2 weeks after the initial injury. Treatment with splinting and analgesic agents was given, along with a recommendation to avoid weight-bearing activities. At the 6-week follow-up, the fracture had healed, allowing the child to engage in weight-bearing activities, and he subsequently resumed normal activities.
Chun-Hao Lin, M.D.
Yi-Cheng Lin, M.D., Ph.D.
N Engl J Med 2023; 389:e50
DOI: 10.1056/NEJMicm2304910

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