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Fifteen-minute consultation: The toddler’s fracture
  1. Nils Wijtzes1,
  2. Hannah Jacob1,
  3. Katie Knight2,
  4. Steffi Thust3,
  5. Gayle Hann1
  1. 1 Department of Paediatrics, North Middlesex University Hospital, London, UK
  2. 2 Paediatric Emergency Medicine, North Middlesex University Hospital, London, UK
  3. 3 Radiology, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Gayle Hann, Department of Paediatrics, North Middlesex University Hospital, London, UK; gaylehann{at}


The toddler’s fracture is a distinct entity among tibial shaft fractures. It is defined as a minimally displaced or undisplaced spiral fracture, usually affecting the distal shaft of the tibia, with an intact fibula. They are often difficult to diagnose due to the absence of witnessed trauma and because initial radiographs may appear normal. Moreover, the presenting complaint (a non-weight bearing child) has a wide differential diagnosis. A detailed history and examination, together with additional imaging and other investigations, is crucial to diagnose a toddler’s fracture. Analgesia and immobilisation are the mainstays of treatment, with follow-up in fracture clinic recommended. Inflicted injury (Note: this article will use the term inflicted injury which is also called non-accidental injury. In the field of safeguarding, there is a move away from using the term ‘non-accidental injury’ due to misinterpretation of the term as being less serious than ‘abusive injury’ and that in child protection reports the term can be easily misread or mistyped as ‘accidental’ injury) should always be considered when red flags for child abuse are present. In this article, we aim to cover the differential diagnoses for toddler’s fracture including indicators that might suggest an inflicted injury.

  • child abuse
  • analgesia

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  • Twitter @HannahCJacob, @_katieknight_, @hann_gayle

  • Contributors NW, HJ and GH planned the manuscript. NW, ST and GH contributed to literature search. NW wrote the body of the text and tables. GH added the figures. All authors contributed on the editing of the article. NW revised the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.