| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Children's Hospital Medical Center Cincinnati, OH 45229-3039
Toddler's fracture was first described by Dunbar et al. [1] and refers to an occult non-displaced fracture of the tibia that occurs in young children who are just beginning to ambulate. The fracture typically occurs between 9 months and 3 years of age. The theory is that when the new stresses associated with ambulation are applied to bone that has not previously been accustomed to such stresses in the nonambulatory infant, fractures may occur. Children present with failure to walk or refusal to bear weight on the affected extremity. It is often not obvious on clinical examination that the problem is within the tibia, and radiographic examination of any or all of one or both lower extremities may be requested [1]. The fractures are often obliquely oriented and may not be seen on frontal and lateral views but are often depicted on oblique views. When the initial fracture is not visualized, periosteal reaction is usually identified on follow-up radiographs [1,2,3,4]. Toddler's fractures usually heal without treatment; therefore, identification of these fractures is more important for alleviating parental anxiety and avoiding unnecessary diagnostic tests to identify other potential causes of the patient's symptoms than it is for planning therapy. Although the term "toddler's fracture" typically pertains to an occult fracture of the tibia, similar fractures may occur in other bones of the lower extremities in toddlers [2,3,4]. Fractures have been described in both the cuboid [2] and the calcaneous [3]. With both types of fractures, initial radiographs often show normal findings, bone scintigraphs reveal increased focal uptake, and delayed radiographs show sclerosis at the base of the cuboid or posterior aspect of the calcaneous [2, 3]. In addition, a subtle buckle-type fracture of the proximal tibial metaphysis has been described as an additional type of toddler's fracture [4].
I recently encountered a 15-month-old male infant who presented with failure to bear weight on the left leg. Initial radiographs of the left lower extremity, including dedicated images of the tibia and fibula, failed to reveal an abnormality. Because the patient continued to have symptoms, a second radiograph was obtained 2 weeks later; it showed periosteal reaction along the lateral shaft of the distal fibula (Fig. 4). The fracture had both the clinical and radiographic features of a toddler's fracture but involved the fibula rather than the tibia. The patient's symptoms eventually resolved with conservative treatment.
|
Because the tibia is the major weight-bearing bone of the lower leg, it is the structure most commonly affected by toddler's fractures. Other bones, however, such as the cuboid, calcaneous, and fibula may also be involved by these fractures. Attention should be given to the fibula when evaluating radiographs of children who are being examined for toddler's fractures because the fibula is a potential location for a toddler's fracture.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  T P Kinnaird and R C Beach Fractured fibula can mimic irritable hip Arch. Dis. Child., February 1, 2003; 88(2): 167 - 167. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
