Toddler’s Fracture

7/2/2008

Toddlers are like puppies, bouncing around and taking falls on a regular basis. But sometimes an apparently benign tumble is accompanied with a twist or turn of the lower leg that causes a small but painful fracture of the tibia, a bone in the lower leg.

“Toddler’s fracture” can be very difficult to diagnose because the tiny fracture does not push the bone out of place. The fall itself may have been unseen, so parents and physicians have no reason to suspect a crack in the bone as the cause of the pain.

A child with a toddler’s fracture often is brought to the doctor because he or she has been limping or refusingto walk. The doctor may find no physical sign of damage from his exam because, unlike most fractures, toddler’s fracture usually leaves no marks or swelling. The bone may even appear normal in X-rays.

How then can toddler’s fracture be diagnosed properly? I usually refer any toddler with a normal X-ray and an unexplained limp to a pediatric orthopedist. This specialist will probably order a specific X-ray view of the tibia called an internal oblique. Occasionally even this view is not fully definitive and a nuclear scan of the leg bone may be required. It is important to get a proper diagnosis of this persistent leg problem in order to rule out serious illness such as leukemia or other form of cancer.

Happily these difficult-to-diagnose fractures usually heal fully in a healthy child in about three to five weeks. If healing is not progressing as expected, the orthopedist may immobilize the leg in a cast for several weeks.

Most of these fractures require nothing other than TLC and good follow-up with the orthopedist During the recovery period parents should make sure the child is eating a well-rounded diet, getting plenty of fluids, and limiting rough play to avoid re-injuring the leg.