![]() ![]() ^ Dunbar JS, Owen HF, Nogrady MB, McLeese R (September 1964)."Sonographic diagnosis of toddler's fracture in the emergency department". ^ Miller JH, Sanderson RA (December 1988)."Expanding the concept of the toddler's fracture". ^ John SD, Moorthy CS, Swischuk LE (1997)."Radionuclide bone imaging in toddler's fracture". ^ De Boeck K, Van Eldere S, De Vos P, Mortelmans L, Casteels-Van Daele M (January 1991)."Toddler's fracture: presumptive diagnosis and treatment". ^ a b c Halsey MF, Finzel KC, Carrion WV, Haralabatos SS, Gruber MA, Meinhard BP (2001)." 'Toddler's fracture'? A recognised entity". ![]() "Childhood accidental spiral tibial (CAST) fractures". ^ a b c Mellick LB, Milker L, Egsieker E (October 1999).A new terminology has been proposed, which defines toddler's fracture as a subset of childhood accidental spiral tibial (CAST) fractures. The condition was initially recognised by Dunbar and co-workers in 1964. Treatment consist of a long leg orthopedic cast for several weeks. Recently, ultrasound has been suggested as a helpful diagnostic tool. It could be useful in special cases such as children with fever, those without a clear trauma or those in which the diagnosis remains unclear. However, since treatment can also be initiated in the absence of abnormalities, this appears to have little value in most cases. In some cases, an internal oblique radiography and radionuclide imaging can add information to anterior-posterior and lateral views. Other possible fractures in this area, occurring in the cuboid, calcaneus, and fibula, can be associated or can be mistaken for a toddler's fracture. Contrary to CAST fractures, non-accidental injury typically affect the upper two-thirds or midshaft of the tibia. The condition can be mistaken for osteomyelitis, transient synovitis or even child abuse. After 1–2 weeks however, callus formation develops. The initial radiographical images may be inconspicuous (a faint oblique line) and often even completely normal. On clinical examination, there can be warmth and swelling over the fracture area, as well as pain on bending the foot upwards ( dorsiflexion). Typical symptoms include pain, refusing to walk or bear weight and limping - bruising and deformity are absent. The proposed mechanism involves shear stress and lack of displacement due to the periosteum that is relatively strong compared to the elastic bone in young children. It occurs after low-energy trauma, sometimes with a rotational component. The fracture is found in the distal two thirds of the tibia in 95% of cases, is undisplaced and has a spiral pattern. Toddler's fractures are bone fractures of the distal (lower) part of the shin bone ( tibia) in toddlers (aged 9 months-3 years) and other young children (less than 8 years). Childhood accidental spiral tibial (CAST) fractures ![]()
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