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Toddler's fractures are nondisplaced injuries, often to the tibia or metatarsal base, challenging to diagnose on initial X-rays. This study reviews their diagnosis and treatment, recommending specific criteria for the term "toddler's fracture".

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Area of Science:

  • Pediatric Orthopedics
  • Trauma Surgery
  • Radiology

Background:

  • The term 'toddler's fracture' was initially defined as a nondisplaced distal tibia fracture in children aged 9 months to 3 years.
  • Definitions have evolved, encompassing varied locations and age ranges, necessitating a clear, consistent terminology.
  • Distinguishing these fractures from other pediatric conditions like osteomyelitis or child abuse is critical.

Purpose of the Study:

  • To provide a comprehensive overview of toddler's fractures, synthesizing existing literature.
  • To compare diagnostic and therapeutic strategies for these injuries.
  • To refine the definition and application of the term 'toddler's fracture'.

Main Methods:

  • Retrospective analysis of pediatric skeletal injuries from 2012-2017.
  • Focus on patients aged 9 months to 3 years with nondisplaced fractures.
  • Review of diagnostic modalities including ultrasound, CT, and scintigraphy.

Main Results:

  • Identified 57 cases of nondisplaced distal tibial metaphyseal fractures (0.4%) and 147 cases of first metatarsal base fractures (0.9%) in toddlers.
  • Nondisplaced fractures are often difficult to diagnose on initial X-rays.
  • Differential diagnosis includes osteomyelitis, synovitis, tumors, and child abuse.

Conclusions:

  • Recommend using 'toddler's fracture' for nondisplaced distal tibia fractures, adhering to original criteria.
  • Suggest including first metatarsal fractures in this category due to their frequency, under specific conditions.
  • Emphasize the importance of advanced imaging when initial diagnosis is unclear.