8 A survey of members of the Pediatric Emergency Research Canada network with a 73% (153 of 211) response rate revealed considerable variation among Canadian emergency physicians in the management of TF. Practice variation in management of TF was recorded in the United States 10 and Canada. 5, 6 Over the years several guidelines have recommended pathways for treating TF however, a recent e-mail survey of all members of the Pediatric Emergency Research Canada network suggested considerable practice variation in management of TF. children each year at the Royal Hospital for Sick Children in Edinburgh, Scotland, to children at Scotland’s Royal Aberdeen Children’s Hospital. 4 The incidence of TF varies between reports and ranges from 2. 3 The nomenclature was changed in the 1990s to childhood accidental spiral tibial fracture or CAST fracture to encompass a more comprehensive definition including children up to age 8. 1, 2 Toddler’s fracture was first coined by Dunbar et al in 1964 as a nondisplaced spiral or oblique fracture of the distal third of the tibia extending downward medially. This mechanism usually occurs when a toddler trips while walking or running, or when falling from a height. The mechanism of injury is usually rotational force through the tibia with the foot and ankle fixed, while the proximal leg rotates internally. Toddler’s fractures occur in young ambulatory children, usually between 9 months and 3 years of age. Limping in a child is concerning for both the child’s family and for health care providers who need to consider a diagnosis of toddler’s fracture (TF). For most children, no orthopedic follow-up is needed. A controlled ankle motion boot or a short leg back slab are preferred because they are associated with fewer complications and can be removed by the family or the family physician. Treatment of both confirmed TF and presumed TF is conservative with immobilization. Toddler’s fracture is diagnosed clinically and frequently can be documented with radiographs. Tenderness at the fracture site is common but is at times hard to elicit in young children. Children usually present limping or refusing to walk. It is caused by a twisting injury while tripping, stumbling, or falling. What is the best method to confirm the diagnosis? What method should be used to immobilize the affected limb and for how long? Is follow-up with a pediatric orthopedic surgeon needed?Īnswer Toddler’s fracture, also called childhood accidental spiral tibial fracture or CAST fracture, is a fracture unique to ambulatory infants and young children. I understand that there is considerable variation in practice regarding management of TF. The history, physical examination, and radiology assessment revealed a toddler’s fracture (TF). Question A 2-year-old boy presented to my office 2 days after he started limping.
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