Lightning Learning: Toddler's Fracture

Lightning Learning: Toddler's Fracture

A Toddler’s Fracture is typically a spiral fracture of the tibia when a child falls and twists their leg with low energy.
— advice is based on local guidelines & procedures

What?

A Toddler’s Fracture is typically a spiral fracture of the tibia, either minimally or non-displaced.

Common in children who are learning to walk, ages 9 months to 3 years.

The vast majority of Toddler’s Fractures aren’t indicative of non-accidental injury.

Why?

This can happen when a child falls and twists their leg with low energy.

For example:

…their leg gets caught (whilst sitting on an adults lap) as they’re coming down a slide together, or

…slipping off a toy on the carpet.

There are subtle signs to look for that can easily be missed...

  • Won’t put foot down on the affected side (lifts leg up – stork position).

  • Often no physical signs of a fracture but will not weight-bear.

  • Axial load: place hand at knee and ankle, then gently twist the leg – this would elicit pain.

How?

Once a fracture is suspected, what do we need to do next?

  1. AP and lateral x-rays or analgesia

  2. Read local guidance

  3. Visible lucent line? Soft wrap/pop above knee and refer to fracture clinic

  4. Not visible? Treat clinically, soft wrap/pop above knee and review in 2 weeks looking for periosteal reaction

  5. Consider a Limp pathway if there's no trauma

  6. Always think child protection! Safeguarding referral fracture under 2, Health Visitor form (ages 2-5 years)

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