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Child Abuse

Spiral Fractures in Toddlers

07/26/2006

Question:

Please give me information regarding these types of fractures and toddlers. I would like to know if the information I have found on other websites is correct. I have learned that these types of fractures are quite common in toddlers. Is that true? why or why not? Thank you,

Answer:

Toddler's fractures are fractures in the distal part of the tibia (the larger bone in your shin). With Toddler's fractures, children usually refuse to bear weight on the leg that is broken. On exam of the area, you may or may not see obvious deformity or bruising. Often the child will have pain and swelling at the area if you touch it. When you look at X-rays for a toddler's fracture, initial X-rays may not show the fracture in almost half of the cases. Usually children with toddler's fractures are 12-94 months old and are common in children less than 8 years old. Toddler's fractures can also be known as spiral fractures. The mechanism of the injury is usually trivial (i.e. tripping or twisting the ankle) and usually involves a twisting or rotational injury. A toddler's fracture can be suspicious for child abuse in a child who is not yet walking or who does not have a consistent history for the injury. Toddler's fractures are usually treated by an orthopedic doctor by casting the leg for 5-6 weeks.

There are other types of spiral/oblique fractures involving the tibia and other bones.  Some of the older literature suggests that a spiral fracture is always due to child abuse.  This is not correct.  Spiral fractures may be caused by an abusive incident, but they also may result from accidental trauma.

Megan McGraw MD / Robert Shapiro MD

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Response by:

Robert Shapiro, MD
Professor of Clinical Pediatrics
College of Medicine
University of Cincinnati