A Toddler with a Sudden Limp

Differential Diagnosis

• Hairline spiral fracture of the tibial diaphysis (also known as a toddler fracture)
• Irritable hip
• Subacute osteomyelitis
• Transverse fractures of the proximal tibial metaphysis (also known as trampoline fracture)

Diagnosis
The images reveal a hairline spiral fracture of the tibial diaphysis, or a toddler fracture.

Learnings

• Toddler fractures are often identified clinically in a walking toddler who is limping or unable to put any weight on their leg, most commonly after a minor fall. They can also occur when a sneaker gets caught on the side of a playground slide (especially if the child is riding down on the parent’s lap). Sometimes there may be no history of trauma, and the diagnosis is suspected based on presenting symptoms
• Tibia and fibula films are the preferred radiographic study for evaluation. In this case knee and ankle films were performed, and partially captured the fracture

Pearls for Urgent Care Management and Consideration for Transfer

• Closed reduction and long leg casting is used to treat most patients. These can be administered in the urgent care center according to the provider’s skill level, or transferred emergently to a specialist or higher-acuity setting

Acknowledgment: Images courtesy of Teleradiology Specialists.