TODDLER FRACTURE
It is a 2 year old girl referred to assess limping of the left lower leg. There is a history of minor trauma some days ago. An x-ray of left leg was reported with periostal thickening and increase in bone density. In the bone scan it can be seen in the phase of pool and delay images a marked increase in perfusion and osteoblastic uptake of curvilinear shape in the left femoral shaft. The rest of the skeleton is normal.
The mechanism is usually a torsion of the tibia or femur without ends separation.
According to
Jadhav et al., there are many subtle injuries which will be missed if the
radiologist is not aware of them and is not actively searching for them. The
common elusive injuries include: (1) plastic bending fractures, (2)
sternoclavicular dislocation, (3) epiphyseal-metaphyseal injuries in older child,
(4) buckle fractures, and (5) Toddler fracture types I and II. Although the
toddler fracture of the tibia is one of the most common in children younger than
age 2 years (1).
Tibial fractures are the most common in children (2).
References:
1 Jadhav SP, Swischuk LE. Commonly missed subtle skeletal injuries
in children: a pictorial review. Emerg Radiol. 2008 Nov;15(6):391-8. Epub 2008
May 28.
2 Mashru RP, Herman MJ, Pizzutillo PD. Tibial shaft fractures in
children and adolescents. J Am Acad Orthop Surg. 2005 Sep;13(5):345-52.
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