Immobilization Versus Observation in Children With Toddler’s Fractures: A Retrospective Review


While long leg casts have been historically recommended for immobilization of toddler’s fractures, short leg casts are often used by treating physicians. Others question whether any immobilization is necessary because of the internal stability provided by the thickened periosteum of pediatric bones. The purpose of this study is to review the results of toddler’s fractures treated with long leg casts, short leg casts, or without immobilization. Eighty-five patients were included in a retrospective review of nondisplaced spiral or oblique tibial shaft fractures in children under 6 years old from 2007 to 2012. Treatments included long leg casts (19), short leg casts (59), and no immobilization (7). Average time to ambulation was 15.5 days. There were 11 casting complications. Only one patient, in a short leg cast, had measurable displacement or angulation. There were no complications reported in the nonimmobilized group. The results suggest that toddler’s fractures can be effectively treated with short leg casts or without immobilization. (Journal of Surgical Orthopaedic Advances 27(2):142–147, 2018)
Key words: immobilization, return to ambulation, tibial shaft fracture, toddler’s fracture

Lauren C. Leffler, MD; Stephanie L. Tanner, MS; and Michael L. Beckish, MD