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Toddler’s Fracture: Important Things Parents Should Know

Toddler’s Fracture: Important Things Parents Should Know

by | Oct 8, 2020 | Fractures

Our team of pediatric orthopedic specialists in the Fracture Clinic understand that accidents happen. When your child gets injured, it can be scary, especially if the child is very young. It is important to understand common fractures, what to do and where to go if it happens to your child.

A fracture is a break in a bone. A toddler’s fracture is the name for a broken bone in the leg that typically occurs in children less than 3 years of age. A toddler’s fracture is a spiral fracture (break) in the tibia (the shin bone). It is considered a low energy break, and usually presents as a hairline (small) crack without significant damage to the bone or surrounding tissue.

As a nurse coordinator in the Scottish Rite for Children Fracture Clinic, Bonnie Ste. Marie, R.N., works closely with families when they come into the clinic. “We see this type of fracture often,” says Ste. Marie. “As a mom myself, I understand the concern of parents when this happens to their young child. It is important to me and the team to provide information every step of the way. This helps the child and parent feel comfortable and assured we provide the best care for each patient.”

How does a toddler’s fracture occur?
This type of fracture is the result of a twisting leg injury and typically occurs during a fall or going down a playground slide.

What are the signs and symptoms of a spiral tibia fracture?

  • One of the first symptoms is that your child will refuse to put weight on the injured leg and will withdraw the foot by bending at the knee with attempts to stand or weight bear.
  • Due to your child’s young age, it is difficult for them to communicate where the pain is coming from and they will often complain of pain in the entire lower leg or specifically point to the foot.
  • Mild swelling to the lower leg or foot is possible but rare in most cases.

 How is a toddler’s fracture diagnosed?

  • History – You will give a detailed description of the activity that caused the injury.
  • Physical Exam – A physical exam is performed, from the hips down to the feet. Typically, there is tenderness to touch in the tibia or shin bone area and pain with rotation of the lower leg. The hips and knees should be pain free and have full range of motion.
  • Imaging – X-rays may be taken of the lower leg.
    • In most cases, the fracture is very small, and the X-rays will show that the bone is still in place, or in normal alignment.
    • In some cases, X-rays will not show any obvious fracture. This is called an occult fracture and is diagnosed during a physical exam.

What is the treatment for a toddler’s fracture?
The majority of these fractures are stable injuries and treatment is aimed at providing comfort and modifying activities. A hard cast is rarely necessary. Evidence shows that a walking boot and allowing the child to continue to walk as tolerated produces similar results to wearing a cast or splint but with fewer risks of complications. Children will generally wear the walking boot for around four weeks.

The Fracture Clinic in Frisco is open Monday – Friday from 7:30 a.m. to 4:30 p.m. The clinic accepts walk-in patients between 7:30 a.m. and 9:30 a.m.

Learn more about the Fracture Clinic.

My Child Has a Buckle Fracture, Now What? – Fracture Clinic Tips

My Child Has a Buckle Fracture, Now What? – Fracture Clinic Tips

by | Jul 3, 2020 | Fractures

A buckle fracture, also known as a torus fracture, is a very common injury for children. Because pediatric bones are softer and more flexible than adult bones, one side of the bone may buckle (or bend) upon itself without disrupting the other side of the bone. These fractures are most commonly seen in the wrist and are often caused by a “FOOSH” (fall on outstretched hand) injury. Buckle fractures can also occur in other bones throughout the body.

These are common injuries that tend to heal quickly with low risk for complications. The typical treatment for a buckle fracture is aimed at keeping the patient comfortable while allowing the bone to heal. Sometimes this may include a cast or splint. Deciding which treatment is best for your child depends on the fracture pattern, the child’s comfort and the parent’s comfort level with the treatment plan.

Most buckle fractures heal well with no long-term complications. Our Fracture Clinic staff are experts at managing fractures in growing children. Learn more about our walk in hours and watch a video to learn what to expect when you visit our Fracture Clinic.

An Approach to Management of Toddler’s Fractures

An Approach to Management of Toddler’s Fractures

by | Jun 2, 2020 | Fractures

Article originally published in latest issue of the Pediatric Society of Greater Dallas newsletter. Written by Gerad Montgomery, M.S.N., FNP-C, and Ray Kleposki, M.S.N., CPNP.

A toddler’s fracture is classified as a tibia shaft fracture in a child age 3 and younger. These patients usually present with either a witnessed or unwitnessed report of low energy trauma to the lower extremity. The mechanism of injury may vary but usually involves some sort of a rotational component. Due to the patient’s age and inability to clearly articulate symptoms or mechanism of injury, these fractures often leave both parents and clinicians anxious and confused. This is confounded by the fact that up to 40% of initial X-rays are negative for obvious bony pathology. To add to the confusion, these fractures usually do not present with swelling or other obvious physical exam findings.

Presentation
The typical patient that presents with this injury is a toddler between the ages of 1 and 3 years with an acute onset of refusal to weight bear or ambulating with a limp.

Three common reports include:

  • History of remote trauma such as a twist and fall.
  • Onset of symptoms after going down a slide with an adult and the patient’s leg getting twisted at the bottom of the slide
  • Unwitnessed incident where patient was playing in another room and eventually found crying on the floor and unwilling to weight bear on the affected extremity.

Regardless of the mechanism, in most cases, the patient will be unable to reliably articulate what caused the injury or where his/her symptoms are arising from. 

Evaluation
When evaluating the patient in this age group, with the presenting complaint of a limp and/or refusal to weight-bear, it is important to consider other conditions that may present in a similar fashion.

Though unlikely, these include:

  • Infection: early presentation of both benign viral infections such as transient synovitis and serious bacterial infections, like osteomyelitis and septic joints, can present with similar initial complaints.
  • Constipation
  • Inflammatory reaction to recent immunizations
  • Chronic or congenital conditions: consider hip dysplasia, cerebral palsy and foot or ankle deformities.

Most of the time, a good history and detailed clinical exam can eliminate dangerous conditions and lead the clinician to an accurate diagnosis. Usually, a step by step exam (starting at the hips and working down to the feet) will reveal pain-free, full range of motion of the hips and knees. This includes classical tenderness to palpation noted over the tibial shaft and pain produced with rotation of the lower leg.  

Treatment
The vast majority of these fractures are stable injuries and treatment is aimed at providing comfort and modifying activities, with the goal of reducing the risk of further injury. Immobilization is appropriate, however a cast is usually not necessary. It has been well documented that a walking boot produces outcomes equivalent to a cast or splint. A removable boot has a lower risk of complications from skin breakdown and higher rate of patient and parent satisfaction. 

Splinting Considerations – When a Boot is Not Available
We frequently see significant skin breakdown after splints or casts used to immobilize patients in this age group. The size of the extremity makes it difficult to properly mold casts/splints in order to prevent friction with skin contact. The most common areas of breakdown are at the back of the heel and anterior crease of the ankle. If you are splinting a patient in this age group, we recommend paying careful attention to the positioning of the foot and ankle and applying extra padding over bony prominences such as the malleoli and at the back of the heel.

The presence of swelling in toddler fractures is minimal and usually not a concern. Therefore, elevation is not a necessary part of the treatment plan, despite the many clinicians and parents who believe that elevation is important for any fracture. While the elevation alone is not harmful, proper elevation techniques should be taught when elevation is recommended.

Proper Elevation – Keep the Heel Off of the Surface
Poor positioning can cause increased pressure leading to skin breakdown. Place a pillow under the calf only, not directly under the knee or heel. Do not assume that immobilization is a benign modality. You must provide the family with warnings and instructions on what to monitor for regarding signs and symptoms of potential complications.

Patient and Family Education
Providing reassurance to the family is a key goal of patient education. These fractures generally heal well with little to no complications in regard to bony healing or future sequela after four to six weeks of immobilization. Additional imaging may be needed in some cases. A child will gradually return to normal activity within a few days of discontinuing activity restrictions and immobilization.
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Learn More About Our Fracture Clinic Walk-In Hours

Learn More About Our Fracture Clinic Walk-In Hours

by | Feb 21, 2020 | Fractures

In many cases, a visit to your pediatrician, urgent care or emergency room is your first stop when your child is hurt. If you are told to follow up with a pediatric orthopedic specialist for a fracture, you can come to the Scottish Rite for Children’s Fracture Clinic during our convenient walk-in hours.

Our Fracture Clinic is open Monday – Friday. Bring your X-ray images on a disc and arrive at our Frisco campus between 7:30 to 9:30 a.m. No appointment needed.

If you have not had X-rays for the child’s new injury, that is okay too. Parents can call 469-515-7200 to request an appointment.

Learn more about our Fracture Clinic.

Get to Know our SRH Staff: Kat Petty, Fracture Clinic

Get to Know our SRH Staff: Kat Petty, Fracture Clinic

by | Jul 15, 2019 | Fractures

What is your role at the hospital? What do you do on a daily basis? 
I am the R.N. coordinator for the Fracture Clinic at our Frisco campus. I coordinate patients’ needs (orders, medications, supplies, phone calls) and manage the overall flow of the clinic. 
The clinic serves patients that have been injured and may have a fracture. We have walk-in clinic hours from 7:30 – 9:30 a.m., as well as scheduled appointments throughout the day. It’s a busy place!
What led you to Texas Scottish Rite Hospital for Children? How long have you worked here?
I have been here for exactly two years. When I was looking to transfer out of the hospital setting, I came across a job posting for Scottish Rite Hospital. I did one of my nursing school clinicals at the hospital back in 2010 and I remembered how great of an experience that was. The building was a happy place, the employees were friendly and of course the popcorn smell wafting through the building left an impression on me!
 
What do you enjoy most about Texas Scottish Rite Hospital for Children?
I really enjoy making a difference in children’s lives. Bonus, the management is unlike any I have worked for!
 
What was your first job? What path did you take to get here?
My very first job was when I was 14. I was a daycare worker at a facility that also doubled as a themed party event center on the weekends. My specialty was dressing up as Snow White.
 
What do you like to do in your spare time?
Read, spend time with my husband, feed people, craft, travel, volunteer at my church and plan events.
 
Three words to best describe you:
Patient, considerate, disciplined
 
What would you do (for a career) if you weren’t doing this?
I would be a home decorator or a professional crafter!
 
What’s the most adventurous thing you’ve ever done?
When I was 19, I did a leadership internship and participated in an event called E.S.O.A.L. – Emotionally Stretching Opportunity Of A Lifetime. 
 
This event was fashioned after the Navy Seals boot camp training. For 96 hours, with little to no sleep, we hiked for what felt like a million miles and ran rounds and rounds of obstacle courses. I ate some pretty interesting things (think live mealworms with ketchup and ice cream) and stayed really dirty as we rolled down hills and waded through mud pits. Through the nights, we had sleep-wake cycles: seven minutes to sleep with a rude awakening to jump in a pool of ice water. I’m proud to say that I lasted to the end (only 25% of us made it to the finish line). To date, the hardest and most adventurous thing I have ever done!

An Injury Not to Ignore: Hand & Finger Fractures in Young Athletes

An Injury Not to Ignore: Hand & Finger Fractures in Young Athletes

by | Jan 29, 2019 | Fractures

Believe it or not, hand and finger injuries in kids, especially young athletes are very common. In fact, almost 20 percent of the injuries we see in the Fracture Clinic are hand related injuries. For children, these injuries can occur in a number of ways. For athletes, some of the more common mechanisms we see are from a finger getting struck by a ball, a hand getting stepped on or a finger getting caught in a jersey. While most injuries to the hand or fingers will get better with some time, rest and immobilization, others may require more extensive care or even a surgery to correct alignment or restore function. As the parent of a young athlete, it is important to know when to seek medical treatment.

Recognizing a hand injury in a child is not always easy and may require the attention from an expert who specializes in caring for patients whose bones are still developing. Sometimes, X-rays can appear normal and exam findings can be subtle making it easy to miss or ignore injuries to the hand. If rest is not healing the injury, it is important to know the signs and symptoms where being evaluated by a pediatric specialist is necessary.

Some general “redflags” with finger injuries include:

  • Hearing or feeling a “pop” or “crack” at the time of the injury.
  • Seeing significant swelling immediately after the injury occurs.
  • Noticing differences compared to the same finger on the other hand. Seeing bleeding or drainage at or around the nailbed.
  • Inability to move, straighten or bend the finger or a joint more than two days after the injury.

Gerad Montgomery, M.S.N., FNP-C, tells us that most pediatric hand and finger injuries can be managed with immobilization in a cast or splint. However, when there is significant displacement of fracture, injuries to ligaments and tendons or damage to the nailbed, surgery may be needed.

Advice for parents of young athletes

  • Teach proper techniques with catching, hitting or throwing a ball.
  • Discourage grabbing a shirt or jersey in fast-moving games like football or tag.
  • Encourage athletes to be aware of surroundings during team sports.

  • Insist that athletes wear proper protective sports equipment when appropriate.
  • Never ignore an injury to the hand or fingers. Though it may be tempting to “push through the pain” and keep playing, these injuries can have serious consequences if they are overlooked. Don’t wait to have it evaluated by a medical professional.

Learn more about fracture care at Scottish Rite for Children in Frisco.