This collagen disorder is the mildest form of OI and fractures tend to begin when a child starts to walk. Of note, on this patient’s physical exam, he was noted to have pronounced blue sclera, one of the characteristic features of osteogenesis imperfecta (OI) Type I. There was also documentation that parents presented immediately after injuries and that these were isolated injuries without other signs of NAT.Īdditionally, a good medical history, including any previous fractures, should be obtained to assess for the possibility of more rare presentations, such as metabolic or connective tissue disorders. In our case, the three previous fractures fit the pattern of age-expected fractures. Nonetheless, with any child presenting with a fracture, it is important to consider if the injury may be due to NAT, as an estimated 1-10% of pediatric injuries seen in the ED are due to abuse. Toddler’s fractures are generally straightforward and are not traditionally associated with abuse. Complications are rare, as the injury often has a low-energy mechanism and young patients heal quickly. Most children will return to ambulation after 3-4 weeks. Orthopedic follow-up should occur within 7-10 days of injury. Plain films may be negative on initial evaluation, however, if injury and presentation are consistent with toddler’s fracture, a CAM boot/short leg splint or cast should be considered and follow-up radiographs should be obtained seven days later. More recent studies, however, have shown that a short leg cast or CAM boot has similar outcomes. Historically, toddler’s fractures are managed non-operatively by immobilization with a long leg cast with orthopedic follow-up. Examples of AP and lateral views of tibial spiral fractures No other bruising or injuries were appreciated. The right leg was neurovascularly intact. He had a small area of ecchymosis to the anterior right shin without obvious deformity. On physical exam, the chid was sitting comfortably, playing with a toy, but refusing to move his right leg or foot. The daycare center also had “nanny cams” and provided videos to the parents showing no specific injury or mistreatment. Additionally, the parents had no concerns about safety at the daycare, as the patient’s sibling attended the same center without any issues. His parents were understandably concerned and the patient’s father reported that this had been his fourth visit to the emergency department for fractures since he started walking at 12 months of age. Daycare staff denied any trauma and noted that the child had been playing happily throughout the morning. Prior to arrival, the patient had been at daycare and was found by staff crying, reporting pain to his right leg. A 3-year-old male presents to the pediatric emergency department with leg pain.
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