Nationwide survey on current management strategies of toddler’s fractures

Seguin, Jade; Brody, Daniel A.; Li, Patricia

doi:10.1017/cem.2017.355

Cited by 15 publications

(28 citation statements)

References 25 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The majority of proven fractures were immobilised, while the majority of suspected fractures were treated with non-immobilisation. These findings are similar to those in reports from Canada and Scotland 5 11. However, in the USA, casting is more common 7 8…”

Section: Discussionsupporting

confidence: 89%

“…Recommendations for treatment of minor tibial fractures vary from full above knee casting,6 above or below knee casting,7 splint, controlled ankle motion boot to no immobilisation; however, the evidence base underpinning these recommendations is scant based on surveys and retrospective case series 8–10. Practice varies within and between institutions 10 11. It is clear that these fractures heal well, and complications of immobilisation are not uncommon 7 10…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

2020

View full text Add to dashboard Cite

ObjectiveTo compare the treatment practices (immobilisation vs non-immobilisation) of toddler fractures and other minor tibial fractures (both proven and suspected) in preschoolers, aged 9 months–4 years, and examine rates of ED re-presentations and complications.MethodsRetrospective chart review of presentations of minor tibial fractures, both proven (radiologically confirmed) or suspected (negative X-ray but clinical evidence of bony injury), in children aged 9 months–4 years presenting to a single tertiary level paediatric ED from May 2016 to April 2018. Data collected included treatment practices, subsequent unscheduled re-presentations (including reasons) and complications (defined as problems relating to the injury that required further active care).ResultsA search of medical records yielded 240 cases: 102 had proven fractures (spiral, buckle or Salter-Harris II) and 138 were diagnosed with a suspected fracture. 73.5% of proven fractures were immobilised, predominantly with backslabs. 79% of suspected fractures were treated with expectant observation without immobilisation. Patients treated with immobilisation were more likely to re-present to ED compared with non-immobilised patients (18/104, 17.3% vs 9/136, 6.6% RR 2.62, 95% CI 1.23 to 5.58). 21 complications were seen in 19/104 (18.3%) immobilised patients. There were eight skin complications (complication rate of 7.7%) and 11 cast issues (complication rate of 10.6%). Two (1.5%) of the 136 patients had complications related to pain or limp. Pain was uncommonly found, although follow-up was not universal.ConclusionIn our centre, proven minor tibial fractures were more likely to receive a backslab, whereas for suspected fractures, expectant observation without immobilisation was performed. Although there is potential bias in the identification of complications with immobilisation, the study suggests that non-immobilisation approach should be investigated.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

2020

View full text Add to dashboard Cite

show abstract

“…37 Although rare, complications associated with cast immobilization include heel ulcers, pressure sores, skin breakdown, cellulitis, and prolonged limping. 23,26,37 Leg splint is an alternate treatment option, with no documented cases of failure. 23 The proposed advantages of splinting include: increased function of the lower limb, easier monitoring, and decreased need for clinical follow-up as the splint can be easily removed at home.…”

Section: Managementmentioning

confidence: 99%

“…This approach is reasonably common, as 1 Canadian study demonstrated 44% of emergency medicine physicians chose not to immobilize in the case of a negative initial radiograph and presumed clinical diagnosis of toddler's fracture. 37 Beyond the initial clinical treatment, another important consideration for the treating physician in the clinic or emergency department is the development of an appropriate follow-up plan. Most toddler's fractures can likely be treated primarily with reassurance and discussion of prognosis and healing.…”

Section: Managementmentioning

confidence: 99%

The Toddler's Fracture

Wang

Doyle

Smit³

et al. 2021

Pediatr Emer Care

View full text Add to dashboard Cite

Objective:The tibial toddler's fracture is an important diagnosis in both emergency and urgent care, presenting as acute onset lower extremity pain or limping in a young child. Diagnosis and management may be challenging because of an extensive differential diagnosis. The objectives of this study were to provide an overview of the toddler's fracture and to guide clinicians by summarizing up to date literature for both diagnosis and management this common condition.Methods: This study analyzed literature from the PubMed database from the years of 1964 to 2018. The main focus was on the diagnosis and management of the toddler's fracture.Results: This review demonstrates that diagnosis is primarily made through history and physical examination, as radiographs are often negative at initial presentation. Treatment involves a short period of immobilization, which can be facilitated through the use of a cast, a splint, or no external support. Successful healing and a full return to normal activities and development are near universal.Conclusions: Although a stable fracture with an excellent prognosis, opportunities exist to improve toddler's fractures diagnosis and treatment protocols, to optimize clinical management.

show abstract

“…Patients with obvious fracture on radiographs should be placed into a long leg cast, but the management of suspected, occult fractures that are not visible on radiographs is controversial. Seguin et al surveyed 153 U.S. orthopaedists about their management of suspected occult toddler fractures and found that 44% of survey respondents treated the patient without a cast initially, 22% immobilized the leg in a short leg splint, and 14% immobilized the leg in a long leg cast 23 . At our institutions, these patients are immobilized in a long leg cast and follow-up radiographs are made in the office 2 to 3 weeks after initial presentation.…”

Section: Casting With or Without Closed Reductionmentioning

confidence: 99%

Tibial Shaft Fractures in Children and Adolescents

et al. 2019

View full text Add to dashboard Cite

Tibial shaft fractures are common in the pediatric population. » Traditionally, the majority of pediatric tibial fractures have been managed nonoperatively, but surgical rates are increasing. » Management includes closed reduction and casting, flexible nailing, plate osteosynthesis, external fixation, and rigid intramedullary nailing. » Gustilo-Anderson grade-2 and 3 open pediatric tibial shaft fractures have higher complication rates than closed fractures. » The majority of pediatric tibial shaft fractures have excellent outcomes with an expectation for return to full activities. Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A418).

show abstract

Nationwide survey on current management strategies of toddler’s fractures

Cited by 15 publications

References 25 publications

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

The Toddler's Fracture

Tibial Shaft Fractures in Children and Adolescents

Contact Info

Product

Resources

About