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Case
The patient is a 2-year-old girl who is brought to your urgent care center by her parents several hours after jumping on a trampoline with her friend, but that she “seemed fine” when the mother picked her up to come home.
View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.
The Resolution
Differential Diagnosis
- Acute transverse fracture of the proximal tibial metaphysis
- Hairline spiral fractures of the tibial diaphysis (ie, a toddler fracture)
- Irritable hip
- Subacute osteomyelitis
Diagnosis
The x-ray shows an acute transverse fracture of the proximal tibial metaphysis—an acute Salter type II “trampoline fracture” of the proximal tibia.
Learnings/What to Look for
- Trampoline fractures typically occur in children 2 to 5 years of age while jumping on a trampoline (or other jumping surface) with another, heavier individual
- The upwards bending/recoil of the jumping surface after the heavier partner’s jump exerts excessive axial load on the tibia of the younger lighter child concomitantly descending on the trampoline with extended knees. Immature bones of the children are soft and less resistant to the kinetic energy of the axial load, leading to a proximal tibial impacted fracture
- Radiographic findings include a transverse impacted fracture in the proximal tibial metaphysis. The fractures are usually not angulated or displaced. Bilateral fractures can occur
Pearls for Urgent Care Management and Considerations for Transfer
- Treatment is usually conservative with immobilization. The fractures usually heal without permanent disability or impairment
Acknowledgment: Images and case presented by Teleradiology Specialists, www.teleradiologyspecialists.com.
A 2-Year-Old Girl with Leg Pain After Jumping on a Trampoline