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Immobilization Versus Observation in Children With Toddler's Fractures: A Retrospective Review
Lauren C Leffler1, Stephanie L Tanner1, Michael L Beckish2
1Greenville Health System, Greenville, South Carolina.
Insights
Short leg casts or no immobilization are effective for toddler's fractures, offering faster ambulation. This study reviewed treatments for pediatric tibial shaft fractures, finding comparable outcomes to long leg casts.
Area of Science:
- Pediatric Orthopaedics
- Pediatric Traumatology
- Pediatric Bone Healing
Background:
- Traditional treatment for toddler's fractures involves long leg casts.
- Shorter immobilization methods and non-immobilization are increasingly considered due to pediatric bone's inherent stability.
Purpose of the Study:
- To compare the efficacy of long leg casts, short leg casts, and no immobilization for treating toddler's fractures.
- To evaluate outcomes including time to ambulation and casting complications.
Main Methods:
- Retrospective review of 85 pediatric patients under 6 years old with non-displaced tibial shaft fractures (spiral or oblique).
- Fractures were treated with long leg casts (19), short leg casts (59), or no immobilization (7) between 2007 and 2012.
Main Results:
- Average time to ambulation was 15.5 days.
- Only one casting complication occurred (displacement/angulation in a short leg cast).
- No complications were reported in the non-immobilized group.
Conclusions:
- Toddler's fractures can be effectively managed with short leg casts.
- Non-immobilization is a viable and complication-free treatment option for these fractures.
Abstract:
While long leg casts have been historically recommended for immobilization of toddler's fractures, short leg casts are often used by treating physicians. Others question whether any immobilization is necessary because of the internal stability provided by the thickened periosteum of pediatric bones. The purpose of this study is to review the results of toddler's fractures treated with long leg casts, short leg casts, or without immobilization. Eighty-five patients were included in a retrospective review of nondisplaced spiral or oblique tibial shaft fractures in children under 6 years old from 2007 to 2012. Treatments included long leg casts (19), short leg casts (59), and no immobilization (7). Average time to ambulation was 15.5 days. There were 11 casting complications. Only one patient, in a short leg cast, had measurable displacement or angulation. There were no complications reported in the nonimmobilized group. The results suggest that toddler's fractures can be effectively treated with short leg casts or without immobilization. (Journal of Surgical Orthopaedic Advances 27(2):142-147, 2018).