Toddler's fracture: presumptive diagnosis and treatment

Area of Science:

• Pediatric Orthopedics
• Radiology
• Emergency Medicine

Background:

• Toddler's fracture diagnosis is often delayed due to initial negative radiographs.
• Clinical presentation can be subtle, complicating early identification.
• Accurate diagnosis is crucial for timely and appropriate management.

Purpose of the Study:

• To evaluate the accuracy of presumptive toddler's fracture diagnosis with negative initial radiographs.
• To identify differentiating characteristics in history, gait, or physical examination for toddler's fractures.
• To establish evidence-based recommendations for managing suspected toddler's fractures.

Main Methods:

• Retrospective study of 39 children with presumptive toddler's fracture diagnosis.
• Analysis of initial clinical findings (history, gait, physical exam) and follow-up radiographs.
• Comparison of confirmed toddler's fractures versus those without a fracture.

Main Results:

• 41% (16 out of 39) of presumptive diagnoses were confirmed on follow-up radiographs.
• No specific clinical characteristic reliably predicted the presence of a toddler's fracture.
• Initial negative radiographs did not exclude the diagnosis.

Conclusions:

• A presumptive diagnosis of toddler's fracture is warranted when clinical suspicion is high, even with negative initial radiographs.
• Recommend immediate long-leg casting for suspected toddler's fractures with acute injury history, inability to walk/limp, and no constitutional signs.
• This approach aims to prevent diagnostic delays and ensure prompt treatment for pediatric tibial fractures.