TOddler's fractures

HPI:
Toddler with history of osteogenesis imperfecta type 1 presented after a fall resulting in bruising to right lower extremity, fussiness. 

Exam:
vs normal
5 cm bruise to mid right shin, 2+ DP/PT pulses, cap refill < 2 sec. Full range of motion at hip, knee and ankle joint. Intact plantar, dorsiflexion, leg extension. NO laxity or pain with valgus or varus stress testing.

Imaging:
-Require AP and lateral views of tibia and fibula, ipsilateral knee and ankle
-Imaging below shows a non-displaced spiral tibial shaft fracture

Management:
-Closed reduction with long leg cast
-Follow up with orthopedics in 2 weeks

Anatomy:
-Distal half of tibia, fibula usually remains intact

Discussion:
-15 % of all pediatric fractures
-If not walking yet, consider NAT
-May present with bruising, limping, refusal to bear weight
-Mechanism usually low energy with rotation

Key Points: 
-Toddler fractures common (15 %)
-Consider NAT if not walking yet
-AKA childhood accidental spiral tibia (CAST) fractures
-MOI: low energy, rotation
-History: pain, limp, not bearing weight
-Exam: warmth, pain, bruising, pain with ankle dorsiflexion
-Obtain: xrays AP/lateral tibia/fibula, ipsilateral knee and ankle
-Manage with closed reduction and long leg cast with orthopedic follow up in 2 weeks
-Prognosis: good, usually heal in 3-4 weeks
-Complications: compartment syndrome, leg-length discrepancy, angular deformity