Toddler's fracture: an updated guide on evaluation and management
McKenna C Noe1,2, Dale E Jarka1, Micah K Sinclair3,4
1Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri.
Insights
Toddler fractures, common in children, heal well with various treatments. Newer methods like walking boots may reduce skin issues compared to traditional casts.
Area of Science:
- Pediatric Orthopedics
- Pediatric Traumatology
- Musculoskeletal Injuries
Background:
- Toddler's fractures are frequent pediatric lower extremity injuries.
- Historically treated with casts or splints, these fractures typically have good prognoses.
- Concerns exist regarding complications like skin breakdown with traditional immobilization.
Purpose of the Study:
- To provide an evidence-based review of evaluation and management for toddler's fractures.
- To compare outcomes and complications of different treatment modalities.
- To offer guidance on current practices for these common pediatric injuries.
Main Methods:
- Literature review of studies on toddler's fracture management.
- Analysis of clinical outcomes and iatrogenic complication rates.
- Comparison of traditional immobilization versus removable boots or no immobilization.
Main Results:
- Toddler's fractures generally show minimal risk of displacement or healing failure.
- Traditional casting/splinting is associated with higher rates of skin breakdown.
- Removable walking boots or no immobilization may offer comparable outcomes with fewer complications.
Conclusions:
- Management of toddler's fractures varies widely, indicating a need for standardized guidance.
- Evidence suggests alternative treatments to traditional casting may reduce iatrogenic complications.
- An updated, evidence-based approach to toddler's fracture evaluation and management is warranted.
Abstract:
Toddler's fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler's fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler's fracture.
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Assessment:
1. Clinical Evaluation:
History: