Is immobilisation required for toddler’s fracture of the tibia?

What is toddler’s fracture?

“Toddler’s fracture” describes a non-displaced, isolated, spiral or oblique fracture of the tibia. There are no high quality studies that identify the incidence of these fractures, but orthopaedic and emergency department experience indicate they are common in young children, typically occurring when they are ambulant (that is, toddlers) and between 9 months and 3 years old. They are usually the result of trivial injuries, such as a simple fall to the floor, though the mechanism is often not witnessed. They usually present with irritability and refusal to weight bear on the affected leg. Tenderness at the fracture site may be present, but it can be difficult to elicit.1 The diagnosis is made using radiographs (fig 1), though clinical acumen is important as initial radiographs can be normal in up to two thirds of cases.2 Indeed, both clinical and radiological signs are often unclear, making diagnosis challenging.3 Differentiating between accidental and non-accidental injuries is important in this age group, but we do not discuss this further in this paper.