Observation versus Cast Treatment of Toddler's Fracture: A Prospective Pilot Study

Area of Science:

• Orthopedic Surgery
• Pediatric Traumatology
• Pediatric Orthopedics

Background:

• Toddler's fractures are prevalent pediatric lower extremity injuries.
• Conventional management involves cast immobilization, despite the inherent stability of these fractures.
• The necessity of casting for stable toddler's fractures warrants investigation.

Purpose of the Study:

• To evaluate the efficacy and safety of treating toddler's fractures with observation alone compared to traditional casting.
• To assess ambulation times and healing outcomes in pediatric patients with toddler's fractures under different treatment protocols.

Main Methods:

• A prospective pilot study employing both randomized and observational treatment arms.
• Participants were assigned to either short leg casting or non-immobilized observation.
• Ambulation was monitored via a 21-day log, with radiographic follow-up at 3 and 12 weeks.

Main Results:

• Twenty-one pediatric patients were enrolled; 13 received casts and 8 were observed without immobilization.
• Ambulation times were comparable between the casted and non-casted groups (p = 0.260).
• All fractures healed without complications, and no patients initially managed with observation required conversion to casting.

Conclusions:

• Observation alone appears to be a safe and effective alternative to casting for toddler's fractures.
• Treatment decisions for toddler's fractures should involve shared decision-making between healthcare providers and parents.
• Non-operative management can lead to favorable outcomes in pediatric tibial fractures.