Toddler’s Fractures: Time to Weight-bear With Regard to Immobilization Type and Radiographic Monitoring

Bauer, Jennifer M.; Lovejoy, Steven A.

doi:10.1097/bpo.0000000000000948

Cited by 28 publications

(69 citation statements)

References 19 publications

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“…Bauer et al analyzed the different immobilization types in regard to full weight-bearing in the context of toddler's fractures and found no differences between the immobilization strategies such as long leg cast, short leg cast, boot or long leg splint. After 4 weeks in 98% of patients weight-bearing was reported (20), which is confirmed by our results (Figure 5F). Further age dependency of full weight-bearing can only by observed between the group of 5-10 to 11-17 years old.…”

Section: Discussionsupporting

confidence: 91%

“…Toddler's fracture, as defined in 1964, is a non-displaced, isolated, distal-third diaphyseal spiral tibial fracture in children between 9 months and 3 years of age (18) and therefore constitutes the main part of the age group from 0 to 4 years, as presented in Figures 2A,B, followed by the oblique fracture of the tibia (42t-D/5.1 and 42t-D/5.2). Although the correction potential in this age group is up to 10 degrees valgus and 5 degree varus (19)(20)(21), toddler's fracture does not show any significant dislocation and conservative therapy is always indicated.…”

Section: Discussionmentioning

confidence: 91%

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Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

et al. 2021

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Background: Lower leg fractures are one of the most common fractures in pediatric age. In general, treatment of lower leg fractures is predominantly non-operative, requiring clinical and radiological controls. Nevertheless, it can be observed that in recent years tibial shaft fractures have increasingly been treated surgically. The aim of the present study is to investigate treatment strategies in the context of different fracture types of the lower leg.Methods: In this retrospective chart review, we analyzed 168 children with a diaphyseal fracture of the lower leg admitted to a trauma center between 2005 and 2017. The fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).Results: The frequency of fractures based on the AO-PCCF classification was as follows: Simple oblique fracture of the tibia (43.5%, n = 73), hereof 32 toddler's fractures, multifragmentary oblique fracture of the tibia in 14.3% (n = 24) and simple oblique fracture of both, tibia and fibula in 18 patients (10.7%). Most pediatric fractures were treated conservatively by cast (n = 125). Thirty-seven patients received an ECMES, whereas 3 patients were treated with an external fixator and also 3 fractures were stabilized by plate osteosynthesis. Conservatively treated patients were significantly younger (mean age 6.0) compared to patients treated with ECMES (mean age 10.2) or plate osteosynthesis (PO)/external fixator (EF) (mean age 11.3), even if toddler's fractures (mean age 2.0) are excluded (mean age 7.4). There was no difference in time to full weight-bearing, hospitalization of patients treated with ECMES compared to conservative therapy although ECMES-treated fractures show more instability. The consolidation time was significantly higher in ECMES treated patients compared to conservative therapy.Conclusion: Pediatric patients (≤4 years) with lower leg fractures most often showed simple oblique fractures of the tibia, half of them toddler's fractures, which were treated predominantly by conservative therapy. All in all, the consolidation time was longer in intramedullary nailing (ECMES) than in conservative therapy. Nevertheless, time to full weight bearing and duration of cast was the same in both groups, even though ECMES treated fractures show more instability.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Lower Leg Fractures in Children and Adolescents—Comparison of Conservative vs. ECMES Treatment

et al. 2021

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“…Follow-up imaging may indeed be unnecessary as we and others have questioned. 6,7 No study to date (ours included), however, has studied this directly. We therefore advocate for orthopaedic referral and evaluation of all patients with toddler's fractures, especially considering the erroneously expanded definition in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

Observation Versus Cast Treatment of Toddler’s Fractures

Fox¹,

Enriquez

Bompadre³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Nondisplaced metaphyseal fractures of the distal tibia, or toddler’s fractures, are one of the most common pediatric injuries. Healing typically occurs quickly without sequelae. Treatment ranges from long leg cast immobilization to observation. This study compares short-term clinical and radiographic outcomes of toddler’s fractures treated with long leg casting versus observation. Methods: Patients with toddler’s fractures were offered enrollment and randomization at diagnosis. Because many families opposed randomization, a preference arm was added after one year. All subjects were analyzed as a prospective cohort. Radiographs were obtained at diagnosis and 4 weeks. A modified Oxford Ankle Foot Questionnaire for Children (OAFQ-C) and family satisfaction survey were collected at diagnosis, 4 and 8 weeks. Scores were analyzed using mixed effect models. Family satisfaction surveys were compared using a Wilcoxon rank sum test. Results: Forty-four subjects participated in the study, 34 (77%) in the preference arm and 10 (23%) in the randomized cohort. The median patient age was comparable between the cast and the observation groups, 2.0 versus 1.8 years, respectively. Significant improvement in OAFQ-C scores was observed in both groups over 8 weeks (P<0.01). Patients in the observation group had a higher initial play score than the cast group (P=0.03). The observation group trended toward higher physical scores at all time points (P=0.11). There was no significant difference in emotional scores between groups (P=0.77). No displacement was observed in any patient. Casted patients had significantly more minor complications with 4 patients requiring cast change or removal compared with 0 in the observed group (P=0.01). At 8 weeks, 80% of parents in the cast group were likely or very likely to choose the same treatment compared with 95.6% in the observation group. Family satisfaction scores did not differ between groups (P=0.18). They demonstrated differences in perceived normal walking at 4 weeks, with 50% of casted patients walking normally compared with 92% of observed patients. Over 90% of patients in both groups were reportedly walking normally at week 8. Conclusion: Observation of toddler’s fractures results in equivalent clinical and radiographic outcomes, high family satisfaction and fewer complications compared with treatment with a long leg cast. Level of Evidence: Level II.

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“…31 However, recent studies support management of these stable fractures in a CAM boot (Figure 6). 32,33 Bauer et al 33 showed excellent outcomes with CAM boot immobilization compared with short leg casting and support the management of toddler’s fractures by PCPs using a CAM boot. Return to activity is typically 6 weeks and can be determined by the patient’s symptoms.…”

Section: Toddler’s Fracturesmentioning

confidence: 92%

“…The patient will usually return to full weight bearing on their own by 4 weeks. 33 Follow-up can be arranged according to parent preference if needed. 33…”

Section: Toddler’s Fracturesmentioning

confidence: 99%