The correct reading of the x-ray is: greenstick fracture of the distal tibia. The x-ray was taken and the fracture identified by the urgent care physician. However, the child was placed in a cast splint after referral to hospital, with advice to follow up with an orthopedist.
While the patient could have been casted in the urgent care clinic, tibial fractures in such young children are considered higher risk for abuse; as a matter of policy such cases are typically referred to the hospital so social services staff can get involved immediately.
This case is also a reminder of the challenges in evaluating very young patients, or any patient who is unable to articulate exact location of pain, when the complaint started, and any causative action not witnessed by others.
The treating physician was Sabera Tourian, MD; case presented by Nahum Kovalski, BSc, MDCM.