A 6-Year-Old Boy with Leg Pain After a Hard Impact

 

The Resolution

Differential Diagnosis

• Acute compartment syndrome
• Ankle fracture
• Cortical fracture
• Soft tissue ankle injury
• Greenstick fracture (incomplete fracture)

Diagnosis

The AP view shows a horizontal white line distal to the tibia. The lateral view illustrates a subtle cortical break posteriorly. This is an incomplete fracture.

Learnings/What to Look for

• Pediatric tibial shaft fractures are the third most common long bone fracture in children
• Boys experience this injury more often than girls
• Pediatric tibial shaft fracture patterns:

1. Incomplete – Greenstick fracture of the tibia and/or fibula
2. Complete – Complete fracture of the tibia with or without ipsilateral fibula fracture or plastic deformation
3. Tibial spiral fracture (Toddler’s fracture)—Nondisplaced spiral fracture of the tibia with intact fibula in a child under 2.5 years of age

Pearls for Urgent Care Management and Considerations for Transfer

• These fractures rarely displace, and can typically be managed nonoperatively with a long leg cast for 2 to 3 weeks, followed by another 2–3-week period in a short cast
• Patients can be casted on site or referred to an orthopedic specialist, depending on the clinician’s experience and comfort level in treating younger patients with painful injuries

Acknowledgment: Images and case provided by Teleradiology Specialists, www.teleradiologyspecialists.com.