The Canadian radiologist, John Dunbar (1921-1997) first described toddler fractures in 1964 2. arm wrestling) is also encountered and usually results in spiral or oblique fractures 1,3. Indirect trauma from a fall or a twisting action (e.g. Toddler fractures usually require no treatment and spontaneously heal. Mechanism Most frequently humeral shaft fractures occur as a result of a direct blow to the upper arm (transverse fractures). (Left) X-ray shows a fibula fracture (blue arrow) and a tibial shaft fracture (red arrows) that extends into the ankle joint. If despite multiple views, no fracture can be identified, follow-up radiographs usually will demonstrate slight sclerosis and periosteal reaction. A repeat x-ray in 1 week usually shows sclerosis or periosteal reaction. AP and lateral views should be adequate in children. However, a fracture may only be seen in multiple views. Nondisplaced oblique fracture will be noted in the middle or distal diaphysis of the tibia 9. Initial x-rays may show a non-displaced spiral fracture of the tibia. Internal oblique projection can better demonstrate the fracture in some cases 8.
Radiographic features Plain radiographĬonventional radiographs are all that are required, however, multiple views may be necessary as the fracture is often inapparent on one or more views. Clinical presentationĬhildren typically with vague symptoms, not clearly related to the tibia. Usually, they refuse to weight-bear and are irritable. As such they should not raise the alarm when present in isolation and the correct age group (i.e. ambulating toddlers). Toddler fractures typically occur between nine months and three years of age 1 and are believed to be the result of new stresses placed on the bone due to recent and increasing ambulation.Īlthough early reports 5 suggested that tibial toddler fractures were indicative of non-accidental injury, subsequent work has suggested that this is not the case and that the vast majority are not suspicious 4. It is important to note that this does not include spiral femoral fractures, which should raise suspicion of non-accidental injury 4. The term has sometimes also been used to describe occult fractures of other lower limb bones in the same age group (e.g.
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