The toddler's fracture: A common fracture of the tibia
Here's what you need to know about the Toddler's Fracture if your child has it.
Given the amount of running, jumping, and falling kids do, it’s no surprise that fractures are one of the most common injuries in children. Of course, as parents we do whatever it takes to make sure our child never has to go through a toddlers fracture, but we cannot always be in control.
The good news is that we can identify the signs and get our child treated as soon as possible.
What is Toddler’s Fracture?
A Toddler’s Fracture or Childhood Accidental Spiral Tibial (CAST) fracture is a spiral break in the tibia (the shin bone in your leg), which occurs after a child twists their leg during a fall.
It’s a very low energy break. Usually it’s a hairline crack without significant damage to the bone or surrounding tissue. This fracture occurs most commonly in infants from nine months to three years of age.
How to tell if your child has Toddler’s Fracture
If your child had a minor fall or accident, and is limping or unable to put any weight on their leg, he or she could have a Toddler’s Fracture.
The injured leg is rarely significantly swollen but its classically tender and especially sensitive to any rotation. You can test this by asking your child to turn their foot outward. This recreates the same rotational force that caused the initial crack.
You will need to send your child to the hospital to get it checked by a doctor.
What doctors will do
Doctors that are suspicious of this injury will order x-rays of the leg. X-rays will diagnose the injury, and a hairline crack can likely be seen in the tibia.
X-rays are also useful to measure the bone alignment and to make sure the break didn’t cause the bone to shorten more than 1 cm, or bend more than 10 degrees.
But remember that in the vast majority of cases, the crack is very small and the bone remains perfectly aligned.
In fact, sometimes the x-rays won’t show any crack. But doctors with a high suspicion of this injury will still treat it as a break once they rule out other causes of a limp.
In such cases without an obvious crack on x-ray, follow up x-rays will show signs of bone healing. This indicates that there was a true break, just too small to be seen on x-ray.
Treatment and care
These injuries almost always heal very well after being casted to protect the bone while it heals.
Doctors will put on a cast from the toes, past the knee, all the way to the mid-thigh.
They often also bend the knee slightly so that kids can’t walk excessively on the injured leg while its in a cast. Although recent studies have shown no increased risk of bone displacement or delayed healing when kids are allowed walk on their broken leg within the cast.
X-rays are repeated 2 weeks after the injury to ensure there are signs of healing.
The cast can be removed around 4-6 weeks, as long as the tibia bone is no longer tender. It typically takes 10 weeks for the bone to heal completely
Kids can begin walking again once there is no pain over the break, and x-rays show signs of healing. They also have to rule out low risk of re-injury or displacement at the fracture site before allowing them to walk as usual.
Toddler’s Fracture is a very common injury and it heals quickly. If it happens to your child, try not to give in to the guilt. It’s impossible to be everywhere at once (though that won’t stop you from trying), and most broken bones in children aren’t serious.