Toddler’s fracture, also known as childhood accidental spiral tibial fracture or CAST fracture, is a common and unique fracture involving the tibia bone (shinbone) of the lower leg in infants and toddlers. The common causes include the twisting of legs while falling, tripping, or standing. Limping and refusal to walk are some of the common signs of it.
Toddler’s fracture is common in the early years of walking, usually from nine months to three years. This fracture does not interfere with bone growth or future activities.
Read this post to know about the causes, symptoms, treatment, and outcomes of a toddler’s fracture.
Common Causes Of Toddler’s Fracture
The causes of toddler’s fracture may not always be obvious. Any injury or fall that exerts pressure on the tibia may increase the risk. Common causes may include (1):
- Leg twisting while running or walking
- Foot twist while sliding down on slides, especially while sitting on someone’s lap
These injuries can cause shear stress, which causes a force to deform the bone. However, displacement of bone is not seen, and the periosteum (outer layer of the bone) remains intact.
Signs And Symptoms Of Toddler’s Fracture
The following signs and symptoms are seen in a toddler’s fracture (1).
- Pain and swelling over shinbone (tibia)
- Ankle or foot swelling
- Limping all time or sometimes
- Refuses to bear weight on the leg
- Pain on dorsiflexion (bending foot upwards)
- Warmness over the fractured area
Deformation of the leg and bruises over the fractured area is not seen in the toddler’s fracture. Some toddlers may limp but may not remember any injuries. Therefore, you may consider consulting a pediatrician if the toddler limps, irrespective of any knowledge of an injury.
Diagnosis Of Toddler’s Fracture
Doctors may do a physical examination and ask about how the injury happened. X-ray of the lower leg is done to look for a toddler’s fracture. If there is no obvious sign of fracture on X-ray, the toddler may still be treated for fracture considering it as suspected toddler’s fracture case provided there are no other issues.
Anterior, posterior, and lateral X-ray views of leg bones are taken to look for fracture lines. A second X-ray scan is done after 10 to 15 days to confirm the diagnosis in some cases since fracture lines may be visible at this time. Sonographic (ultrasound) imaging is also done in some cases to look for a toddler’s fracture (2).
Treatment For Toddler’s Fracture
Leg immobilization with CAM boots or splints is recommended for confirmed and suspected cases of toddler’s fracture. However, a long leg-cast is not often done if the pediatric orthopedic doctor thinks that the child requires further examination after one or two weeks. Parents are also advised to keep the cast or CAM boots clean and dry.
Three to four weeks of immobilization is recommended for a toddler’s fracture (3). Some children may limp or walk as if they have a stiff leg even after removing the cast or splint. You may notice they walk with their toes turned out. This is normal and gets better with time, and does not require physical therapy.
When To Consult A Doctor?
Seek pediatric care if the toddler has symptoms of a toddler’s fracture. You may also contact or visit the doctor if toddlers develop any of the following signs and symptoms after initial treatment.
- Toe numbness or tingling
- Bluish-purple color of toes
- Cold toes
- Swelling and pain
Consider raising your toddler’s leg above heart level for a few seconds, and if the toes do not become pink within three seconds, you may contact the doctor.
Prognosis Of Toddler’s Fracture
The prognosis of toddler’s fracture is good regardless of treatment strategies. Toddler’s fracture may heal in three to four weeks, and the toddler can resume normal activities afterward. Growth plates are not affected in this fracture, and there is no risk of bone deformity or growth problems (4).
Studies have not noted common fracture complications such as nonunion, refracture, or displacement in toddler’s fractures. Skin breakdown from casting or splinting is rarely seen. Toddler’s fractures do not limit future sports or physical activities (5).
Toddler’s fracture is common, and it usually occurs in the initial years of walking. Doctors may do certain examinations to differentiate non-accidental fractures in some toddlers. You may not remove CAM boots or splints before the recommended time since this may affect the healing process. Never hesitate to contact a pediatrician if you are concerned or if the toddler has any symptoms during the healing period.