Edited by Amy Steele, David Evans - 7/1/2021
Descriptors
Complete, incomplete, nondisplaced (Toddler's fracture)
Exam Pearls
Pain, ecchymosis, deformity, limping/unable to bear weight
Evaluate for open fracture (slow continuous ooze or obvious)
Always have high concern for compartment syndrome! (presentation is different in pediatrics--analgesia, anxiety, agitation)
Workup
Radiographs: AP and lateral of tib/fib, consider ipsilateral ankle and knee to rule out injury
Other imaging: CT if concern for physeal or joint involvement, MRI for occult fx
Labs: standard trauma
Other: NA
Management
Need for acute intervention: Yes, immobilization with reduction
Weight-bearing and range of motion: Non-weight bearing
Type of immobilization: Bivalved long leg cast
Admission or discharge status: Depends on indications below
Anticoagulation: Not standard
Antibiotics: Perioperative unless open
Surgical Indications
Absolute: Open Fracture
Closed fracture with unacceptable alignment:
- Greater than 50% translation
- Greater than 1cm of shortening
- Greater 5-10 degrees of angulation in the sagittal and coronal planes
Not an indication: Toddler’s fractures, acceptable alignment can be treated in long leg cast (usually bivalve acutely, this to be done under conscious sedation in the ED)