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.”
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?
AP and lateral x-rays or analgesia
Read local guidance
Visible lucent line? Soft wrap/pop above knee and refer to fracture clinic
Not visible? Treat clinically, soft wrap/pop above knee and review in 2 weeks looking for periosteal reaction
Consider a Limp pathway if there's no trauma
Always think child protection! Safeguarding referral fracture under 2, Health Visitor form (ages 2-5 years)
