Current diagnosis and management of toddler's fracture

• Published in: Anales de Pediatría 2020-05, Vol.92 (5), p.262-267
• Main Authors: Sandra Llorente Pelayo, Juan Rodríguez Fernández, M. Teresa Leonardo Cabello, Mónica Rubio Lorenzo, M. Dolores García Alfaro, Carmelo Arbona Jiménez
• Format: Article
• Language: Spanish
• Subjects: Diagnóstico; Fractura de los primeros pasos; Fractura de tibia; Manejo terapéutico
• ISSN: 2341-2879; 2341-2879

Introduction: Toddler's fracture is an accidental spiral tibial fracture, characteristic of the early childhood. The objective of this study is to determine the incidence and current diagnosis and management of this disorder. Patients and methods: A retrospective study was conducted on a sample of patients aged 0–3 years diagnosed with a toddler's fracture in a tertiary hospital between years 2013 and 2017. Results: A total of 53 patients were registered (10.6 cases per year). The median age was 2 years, with a slight male predominance. The initial radiograph was normal in 24.5% of patients. With the initial approach, 69.8% of patients were diagnosed with fracture, 11.3% with suspected fracture, and 18.9% with contusion. A follow-up was required in 22% through a control test, using radiographs in 10 patients (pathological 90%), and ultrasound in 5 (pathological 80%, 3 of them with normal initial radiography). The large majority (80.8%) of the patients were immobilised with a cast, while flexible immobilisation or non-immobilisation was used in 19.2%. Complications were found in a 21.4% of patients immobilised with splint, mainly skin injuries (19%). These were more frequent in this group than in those that were not immobilised (21.4% vs. 0%, P = .006); with no significant differences in time to weight-bearing. Conclusions: Radiography has a limited sensitivity for the diagnosis of toddler's fracture. In the group of patients with normal radiography, the use of ultrasound can be helpful to the diagnosis and avoid additional radiation. Even though the most common treatment continues to be immobilisation with a splint, the alternative without rigid immobilisation does not seem to give worse results, even with lower morbidity associated with the treatment. Resumen: Introducción: La fractura de los primeros pasos o fractura de toddler es una fractura espiroidea de tibia propia de la primera infancia. El objetivo es analizar su incidencia y el manejo diagnóstico y terapéutico actual. Pacientes y métodos: Estudio descriptivo retrospectivo de los pacientes de 0 a 3 años diagnosticados en un hospital terciario entre los años 2013 y 2017. Resultados: Registrados 53 pacientes (10,6 casos/año), con una mediana de edad de 2 años y ligero predominio masculino. La radiografía inicial resultó normal en el 24,5%. Con la aproximación inicial, el 69,8% de los pacientes se diagnosticaron de fractura, el 11,3% de sospecha de fractura y el 18,9% de contusión. El 22% precisaron