Toddler's fractures are bone fractures of the distal (lower) part of the shin bone (tibia) in toddlers (aged 9 months-3 years) and other young children (less than 8 years).[1] The fracture is found in the distal two thirds of the tibia in 95% of cases,[1] is undisplaced and has a spiral pattern. It occurs after low-energy trauma, sometimes with a rotational component.
The proposed mechanism involves shear stress and lack of displacement due to the periosteum that is relatively strong compared to the elastic bone in young children.[2]
Diagnosisedit
Typical symptoms include pain, refusing to walk or bear weight and limping -bruising and deformity are absent. On clinical examination, there can be warmth and swelling over the fracture area, as well as pain on bending the foot upwards (dorsiflexion). The initial radiographical images may be inconspicuous (a faint oblique line) and often even completely normal.[3] After 1–2 weeks however, callus formation develops. The condition can be mistaken for osteomyelitis, transient synovitis or even child abuse. Contrary to CAST fractures, non-accidental injury typically affect the upper two-thirds or midshaft of the tibia.[citation needed]
Other possible fractures in this area, occurring in the cuboid, calcaneus, and fibula, can be associated or can be mistaken for a toddler's fracture.[4] In some cases, an internal oblique radiography and radionuclide imaging can add information to anterior-posterior and lateral views.[5][6] However, since treatment can also be initiated in the absence of abnormalities, this appears to have little value in most cases. It could be useful in special cases such as children with fever, those without a clear trauma or those in which the diagnosis remains unclear.[3][7] Recently, ultrasound has been suggested as a helpful diagnostic tool.[8]
The condition was initially recognised by Dunbar and co-workers in 1964.[9] A new terminology has been proposed, which defines toddler's fracture as a subset of childhood accidental spiral tibial (CAST) fractures.[1]
^Donnelly LF (September 2000). "Toddler's fracture of the fibula". AJR Am J Roentgenol. 175 (3): 922. doi:10.2214/ajr.175.3.1750922. PMID 10954515.
^De Boeck K, Van Eldere S, De Vos P, Mortelmans L, Casteels-Van Daele M (January 1991). "Radionuclide bone imaging in toddler's fracture". Eur. J. Pediatr. 150 (3): 166–9. doi:10.1007/BF01963558. PMID 2044585. S2CID 11284378.
^John SD, Moorthy CS, Swischuk LE (1997). "Expanding the concept of the toddler's fracture". Radiographics. 17 (2): 367–76. doi:10.1148/radiographics.17.2.9084078. PMID 9084078.
^Miller JH, Sanderson RA (December 1988). "Scintigraphy of toddler's fracture". J. Nucl. Med. 29 (12): 2001–3. PMID 3193212.
^Lewis D, Logan P (May 2006). "Sonographic diagnosis of toddler's fracture in the emergency department". J Clin Ultrasound. 34 (4): 190–4. doi:10.1002/jcu.20192. PMID 16615049. S2CID 9398386.
^Dunbar JS, Owen HF, Nogrady MB, McLeese R (September 1964). "Obscure tibial fracture of infants -- the toddler's fracture". J Can Assoc Radiol. 15: 136–44. PMID 14212071.
External linksedit
April 12, 2024
toddler, fracture, bone, fractures, distal, lower, part, shin, bone, tibia, toddlers, aged, months, years, other, young, children, less, than, years, fracture, found, distal, thirds, tibia, cases, undisplaced, spiral, pattern, occurs, after, energy, trauma, so. Toddler s fractures are bone fractures of the distal lower part of the shin bone tibia in toddlers aged 9 months 3 years and other young children less than 8 years 1 The fracture is found in the distal two thirds of the tibia in 95 of cases 1 is undisplaced and has a spiral pattern It occurs after low energy trauma sometimes with a rotational component Toddler s fractureOther namesChildhood accidental spiral tibial CAST fracturesA toddler s fractureSpecialtyOrthopedic Contents 1 Pathophysiology 2 Diagnosis 3 Treatment 4 History 5 References 6 External linksPathophysiology editThe proposed mechanism involves shear stress and lack of displacement due to the periosteum that is relatively strong compared to the elastic bone in young children 2 Diagnosis editTypical symptoms include pain refusing to walk or bear weight and limping bruising and deformity are absent On clinical examination there can be warmth and swelling over the fracture area as well as pain on bending the foot upwards dorsiflexion The initial radiographical images may be inconspicuous a faint oblique line and often even completely normal 3 After 1 2 weeks however callus formation develops The condition can be mistaken for osteomyelitis transient synovitis or even child abuse Contrary to CAST fractures non accidental injury typically affect the upper two thirds or midshaft of the tibia citation needed Other possible fractures in this area occurring in the cuboid calcaneus and fibula can be associated or can be mistaken for a toddler s fracture 4 In some cases an internal oblique radiography and radionuclide imaging can add information to anterior posterior and lateral views 5 6 However since treatment can also be initiated in the absence of abnormalities this appears to have little value in most cases It could be useful in special cases such as children with fever those without a clear trauma or those in which the diagnosis remains unclear 3 7 Recently ultrasound has been suggested as a helpful diagnostic tool 8 Treatment editTreatment consist of a long leg orthopedic cast for several weeks 3 History editThe condition was initially recognised by Dunbar and co workers in 1964 9 A new terminology has been proposed which defines toddler s fracture as a subset of childhood accidental spiral tibial CAST fractures 1 References edit a b c Mellick LB Milker L Egsieker E October 1999 Childhood accidental spiral tibial CAST fractures Pediatr Emerg Care 15 5 307 9 doi 10 1097 00006565 199910000 00001 PMID 10532655 Sarmah A April 1995 Toddler s fracture A recognised entity Arch Dis Child 72 4 376 doi 10 1136 adc 72 4 376 a PMC 1511261 PMID 7763080 a b c Halsey MF Finzel KC Carrion WV Haralabatos SS Gruber MA Meinhard BP 2001 Toddler s fracture presumptive diagnosis and treatment J Pediatr Orthop 21 2 152 6 doi 10 1097 00004694 200103000 00003 PMID 11242240 Donnelly LF September 2000 Toddler s fracture of the fibula AJR Am J Roentgenol 175 3 922 doi 10 2214 ajr 175 3 1750922 PMID 10954515 De Boeck K Van Eldere S De Vos P Mortelmans L Casteels Van Daele M January 1991 Radionuclide bone imaging in toddler s fracture Eur J Pediatr 150 3 166 9 doi 10 1007 BF01963558 PMID 2044585 S2CID 11284378 John SD Moorthy CS Swischuk LE 1997 Expanding the concept of the toddler s fracture Radiographics 17 2 367 76 doi 10 1148 radiographics 17 2 9084078 PMID 9084078 Miller JH Sanderson RA December 1988 Scintigraphy of toddler s fracture J Nucl Med 29 12 2001 3 PMID 3193212 Lewis D Logan P May 2006 Sonographic diagnosis of toddler s fracture in the emergency department J Clin Ultrasound 34 4 190 4 doi 10 1002 jcu 20192 PMID 16615049 S2CID 9398386 Dunbar JS Owen HF Nogrady MB McLeese R September 1964 Obscure tibial fracture of infants the toddler s fracture J Can Assoc Radiol 15 136 44 PMID 14212071 External links edit Retrieved from https en wikipedia org w index php title Toddler 27s fracture amp oldid 1171091961, wikipedia, wiki, book, books, library,
