Causes / typical injury mechanism: A toddler fracture is a nondisplaced spiral fracture of the tibia in an ambulatory child aged 9-36 months. This fracture usually occurs due to minor trauma, usually a fall or tripping with a twisting of the leg, often unwitnessed. The toddler is often unable to articulate the details of the injury.

Classic history and presentation: This fracture usually presents with inability to bear weight or crawl, or limping in a previously ambulatory child with or without a history of mild trauma. The patient may be in acute distress with irritability and crying, and the patient is unable to walk or crawl with the same proficiency as prior to the injury. There is often pain on palpation over the lower third of the tibia with increased warmth, but this may be hard to confirm in a young child who is crying and resistant to examination.

The diagnosis can be confirmed when a faint hairline fracture is noted on plain radiographs of the tibia. However, the fracture may not show on plain radiographs until about 1-2 weeks after the injury begins to heal. In situations with a negative plain film, a clinical diagnosis is often made based on compatible history and examination.

Treatment for suspected toddler fractures is evolving, with traditional treatment involving immobilization and referral to a pediatric orthopedist for long leg casting. Newer modalities of treatment involve use of controlled ankle motion (CAM) boots or even nonimmobilization.

Prevalence: This is considered to be a common injury. Patients are typically 9-36 months of age.