Management of toddler's fractures.

Question A 2-year-old boy presented to my office 2 days after he started limping. The history, physical examination, and radiology assessment revealed a toddler's fracture (TF). I understand that there is considerable variation in practice regarding management of TF. What is the best method to confirm the diagnosis? What method should be used to immobilize the affected limb and for how long? Is follow-up with a pediatric orthopedic surgeon needed?Answer Toddler's fracture, also called childhood accidental spiral tibial fracture or CAST fracture, is a fracture unique to ambulatory infants and young children. It is caused by a twisting injury while tripping, stumbling, or falling. Children usually present limping or refusing to walk. Tenderness at the fracture site is common but is at times hard to elicit in young children. Toddler's fracture is diagnosed clinically and frequently can be documented with radiographs. Treatment of both confirmed TF and presumed TF is conservative with immobilization. A controlled ankle motion boot or a short leg back slab are preferred because they are associated with fewer complications and can be removed by the family or the family physician. For most children, no orthopedic follow-up is needed.