Toddler's fracture

Introduction

A Toddler’s fracture is a small break, often referred to as a ‘hair-line fracture’, to the shin bone (tibia), the large bone in the lower part of the leg (Figure 1).

Toddler’s fractures are very common in infants and young children under 3 years of age. It is usually caused by a minor fall or a simple twisting of the leg. These fractures heal really well and cause no lasting problems for your child.

What are the symptoms?

Your child may well have started limping, or refused to walk or stand on their leg for no apparent reason. You may not even remember them falling or injuring themselves.

How is it diagnosed?

A healthcare professional may suspect your child has a toddler’s fracture if they are not using their leg as they normally would. This might mean they are refusing to walk, or they are limping. Your child may have an x-ray.

Toddler’s fractures don’t always show up on the first x-ray because it is so small. In some cases, a child will be managed and treated as if they have a toddler’s fracture, even if the X-ray looks normal.

Treatment

The healthcare professional will discuss a treatment plan with you. It is not always necessary to immobilise the leg with a cast/walking boot.

Your child may only require simple painkillers such as Paracetamol and Ibuprofen, and rest.

If they are placed in a cast/walking boot, they will usually wear this for around 2 weeks.

Pain relief and comfort

For the 48 hours, give your child appropriate doses of regular simple painkillers such as Paracetamol and/or Ibuprofen (if allergic/intolerant, inform the treating health professional). These medicines can be purchased over the counter or obtained from a high street pharmacy using the Minor Ailments Service.

Getting back to normal

During the first week following a toddler’s fracture injury, your child may be reluctant to walk or use their leg and this is normal. They may experience some discomfort, but this should not be enough to stop them wanting to play in ways that do not involve using their leg.

As the fracture heals, your child will start to use their leg more and be able to weight bear and walk. If your child has a cast, this can make it harder for your child to move as they normally would.

When the cast is removed, it is normal for a child to be initially hesitant to use their leg, usually for the first few hours, but occasionally may be longer – a day or so. This should improve and they should be able to use and put weight on their leg.

When your child begins to weight bear on the injured leg and walk it may look differently to how they used to, but this should get back to normal over the next few weeks. It can sometimes take a few months for their walking to return to normal.

As long as your child shows signs of gradual improvement, there is no need for further review.

Problems to be aware of

If you notice any of the following, you should seek advice from a Healthcare professional:

• Your child is in pain that is not getting better with pain relief medication.
• Your child has a new pain, or their pain is getting worse.
• Your child’s injured leg, or their foot or toes on the injured side look swollen.
• Your child says that they have a tingling feeling in their injured leg, or their foot or toes on the injured side.
• The plaster cast looks or feels too tight.

Worries or concerns

If the injured leg remains painful after three weeks, or your child is still not willing to use it a few weeks after the cast is removed please contact the virtual fracture clinic (VFC) on 01592 643355 extension 20140 and leave a message. A member of the VFC team will contact you. For urgent problems call 01592 643355 Extension 22685 or concerns out with working hours, please get in touch with NHS 24 on 111.