Features:
(1) fracture in the lower leg or foot secondary to relatively minor injuries in a small child who is just learning to walk or play
(2) associated with limping or leg pain (grimacing, crying, etc)
(3) often difficult to diagnose
(4) requires exclusion of other causes
Types of fractures include:
(1) hairline, oblique fracture of the tibial shaft (classic toddler fracture)
(2) fatigue (stress) fractures of the tibia or fibula
(3) plastic bowing fracture of the tibia or fibula (multiple microfactures associated with axial loading)
(4) buckling type fracture of the tibia or fibula (transverse hairline fracture at the metaphysis after impaction or compression)
(5) fractures of a tarsal bone (talus, cuboid, calcaneus)
(6) fracture of a metatarsal bone
Pain may be elicited by:
(1) lightly twisting the lower leg with one hand near the knee and the other near the ankle
(2) direct thumb pressure over the tarsal or metatarsal bones
Imaging studies:
(1) The fracture line may be very difficult to detect on plain X-rays.
(2) Swelling of adjacent soft tissue may help localize the injury.
(3) Bone scintigraphy or MRI may disclose the fracture line.
(4) A repeat X-ray may demonstrate sclerosis along the healing fracture line.
Conditions that should be excluded:
(1) child abuse
(2) growing pains (see previous section)
(3) bone tumor
(4) osteomyelitis
(5) soft tissue injury
(6) foreign body
