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[Current diagnosis and management of toddler's fracture]
Sandra Llorente Pelayo1, Juan Rodríguez Fernández2, M Teresa Leonardo Cabello1
1Servicio de Pediatría, Hospital Universitario Marqués de Valdecilla, Santander, España.
Insights
Toddler's fracture, a common childhood tibial fracture, is often missed on initial X-rays. Ultrasound can aid diagnosis, and non-rigid immobilization may reduce complications.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Traumatology
Background:
- Toddler's fracture is a spiral tibial fracture common in early childhood.
- Accurate diagnosis and management are crucial for optimal outcomes.
Purpose of the Study:
- To determine the incidence of toddler's fractures.
- To evaluate current diagnostic methods and management strategies.
Main Methods:
- Retrospective study of patients aged 0-3 years diagnosed with toddler's fracture.
- Analysis of diagnostic imaging (radiography, ultrasound) and treatment approaches.
Main Results:
- 53 cases identified (10.6/year); median age 2 years, male predominance.
- Initial radiography missed 24.5% of fractures.
- Ultrasound improved diagnosis in normal initial radiographs.
- Cast immobilization (80.8%) led to more complications than non-rigid methods.
Conclusions:
- Radiography has limited sensitivity for toddler's fractures.
- Ultrasound is a valuable tool for diagnosis, reducing radiation exposure.
- Non-rigid immobilization may be a viable alternative with lower morbidity.
Introduction:
Toddler's fracture is an accidental spiral tibial fracture, characteristic of the early childhood. The objective of this study is to determine the incidence and current diagnosis and management of this disorder.
Patients And Methods:
A retrospective study was conducted on a sample of patients aged 0-3 years diagnosed with a toddler's fracture in a tertiary hospital between years 2013 and 2017.
Results:
A total of 53 patients were registered (10.6 cases per year). The median age was 2 years, with a slight male predominance. The initial radiograph was normal in 24.5% of patients. With the initial approach, 69.8% of patients were diagnosed with fracture, 11.3% with suspected fracture, and 18.9% with contusion. A follow-up was required in 22% required a control test, using radiographs in 10 patients (pathological 90%), and ultrasound in 5 (pathological 80%, 3 of them with normal initial radiography). The large majority (80.8%) of the patients were immobilised with a cast, while flexible immobilisation or non-immobilisation was used in 19.2%. Complications were found in a 21.4% of patients immobilised with splint, mainly skin injuries (19%). These were more frequent in this group than in those that were not immobilised (21.4% vs. 0%, P=.006); with no significant differences in time to weight-bearing.
Conclusions:
Radiography has a limited sensitivity for the diagnosis of toddler's fracture. In the group of patients with normal radiography, the use of ultrasound can be helpful to the diagnosis and avoid additional radiation. Even though the most common treatment continues to be immobilisation with a splint, the alternative without rigid immobilisation does not seem to give worse results, even with lower morbidity associated with the treatment.