paediatric
Toddler's Fracture
intermediate
6 min
28 marks
6 questions
Clinical Scenario
An 18-month-old boy is brought by his parents because he has been refusing to walk since yesterday. The parents report he was playing normally but then cried and wouldn't stand up. There was no observed fall. He has been crying when picked up. On examination, he refuses to weight bear on the left leg. There is no obvious swelling or deformity. He has tenderness on palpation of the distal tibia. His foot is warm with normal sensation.
AP and lateral radiographs of the left tibia in a 2-year-old child demonstrating a subtle non-displaced spiral/oblique fracture of the distal tibial diaphysis (toddler's fracture). The fracture line is better visualized on the lateral view. There is no displacement or angulation. The fibula is intact. Soft tissue swelling is minimal. This fracture is consistent with a low-energy rotational mechanism typical for this age group.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the typical presentation and clinical examination findings.
Question 2 (5 marks)
What are the radiographic features and how do you manage occult fractures?
Question 3 (6 marks)
Describe the mechanism, epidemiology, and why this fracture occurs.
Question 4 (5 marks)
What is the treatment and expected outcome?
Question 5 (4 marks)
What are the differential diagnoses?
Question 6 (4 marks)
How do you differentiate from non-accidental injury?
Exam Day Cheat Sheet
Must Mention
- •Age: 9 months - 3 years (walking child)
- •Pattern: spiral/oblique tibial shaft
- •Fibula: INTACT (key feature)
- •Mechanism: rotational, low-energy
- •Treatment: below-knee cast 3-4 weeks
- •Occult fracture: repeat X-ray 7-10 days
Common Pitfalls
- •Wrong age range
- •Missing fibula status
- •No NAI consideration
- •Not examining hip
- •No repeat X-ray plan
- •Overtreatment