Non displaced spiral or oblique fractures of the tibial shaft may occur in children less than 3 years of age as they begin to walk. In children the diaphysis of the tibia has a great amount of woven bone (soft or weak bone) rather than osteon bone which is hard cortical bone. A thick periosteum prevents displacement of the fracture.
This fracture occurs mostly with twists and falls and
usually has a rotational component. The fracture usually involves the tibia. It
is usually a low energy fracture in the distal tibia.
Differential diagnosis:
- Child abuse: occurs in child not walking yet.
- Osteomyelitis: infection and inflammation of the bone
- Transient synovitis.
The child is usually limping and cannot walk without pain in
the leg.
Initial x-rays are usually normal and after 1-2 weeks a
callus develops. Callus is a new bone. New bone formation is an indication of
an occult fracture. Also look for bowing of the fibula on the x-ray. It is
better to get internal oblique view x-rays if you suspect a toddler fracture.
Ultrasound is useful in the diagnosis of toddler fractures
in the emergency room. Ultrasound can detect a fracture hematoma or changes in
the periosteum.
Treatment:
Rule out constitutional signs: Before you apply the cast,
check to see that there is no constitutional signs.
Some physicians recommend the use of long leg cast in children
with history of acute injury. These children are unable to walk and have a
painful limp. They have negative x-rays. Place in a cast for 3-4 weeks. Apply
the cast and see the patient in 1-2 weeks.
