Toddler Fracture

What is a Toddler Fracture?

A toddler fracture is a specific type of spiral or oblique fracture of the tibia (shinbone) that commonly occurs in young children from 9 months to 3 years who are still learning to walk or run.

Types of Toddler Fractures

Toddler fractures are a type of bone fracture commonly seen in children aged 1–3 years. They are usually stable, minimally displaced (or non-displaced), and result from low-impact trauma, such as a fall while running or jumping. The most common toddler fractures occur in the lower limb but can also affect other bones. Here are the main types:

1. Tibial Toddler Fracture (Most Common)

• Bone Affected: Tibia (shinbone)
• Description: A spiral or oblique fracture of the distal (lower) part of the tibia, often without a fibula fracture.
• Cause: Twisting injury while falling or tripping.
• Symptoms: Refusal to bear weight, limping, pain, and swelling.

2. Fibular Fracture

• Bone Affected: Fibula (the smaller bone of the lower leg)
• Description: Less common than tibial fractures and often occurs alongside them.
• Cause: A fall or direct impact to the lower leg.
• Symptoms: Localised tenderness and swelling, difficulty walking.

3. Femoral Toddler Fracture

• Bone Affected: Femur (thigh bone)
• Description: Can be a spiral, buckle, or transverse fracture of the femoral shaft.
• Cause: Falls from a height (e.g., off furniture) or twisting injuries.
• Symptoms: Severe pain, refusal to bear weight, and leg deformity in displaced fractures.

4. Clavicle Fracture

• Bone Affected: Clavicle (collarbone)
• Description: Usually a greenstick or buckle fracture.
• Cause: A fall onto an outstretched hand or directly onto the shoulder.
• Symptoms: Pain, swelling, and reluctance to move the affected arm.

5. Foot Fractures (Metatarsal & Cuboid)

• Bones Affected: Metatarsals, cuboid bone
• Description: Small, non-displaced fractures of the foot bones, sometimes called a “nutcracker fracture” for the cuboid.
• Cause: Jumping from a height or foot being trapped while twisting.
• Symptoms: Swelling, pain, and limping.

6. Humeral Fracture

• Bone Affected: Humerus (upper arm bone)
• Description: Can be a buckle, spiral, or transverse fracture.
• Cause: A fall onto an outstretched arm or a direct blow.
• Symptoms: Pain, reduced movement, and swelling around the upper arm.

Toddler fractures have an excellent prognosis, as children’s bones heal quickly with minimal complications. However, any suspected fracture in a toddler should be evaluated to rule out more serious injuries.

Why Do Toddler Fractures Occur?

Toddler fractures occur because young children’s bones are still developing and have different mechanical properties compared to adult bones. Here’s why they happen:

1. Bone Structure & Development

• More Flexible & Less Dense Bones: Toddler bones are softer and more flexible than adult bones, making them prone to buckle or spiral fractures rather than clean breaks.
• Higher Water Content: Young bones have more cartilage and water content, which makes them more pliable but also more susceptible to fractures from twisting or bending forces.

2. Typical Toddler Activities & Falls

• Frequent Falls: Toddlers are still mastering walking, running, and climbing, making falls common.
• Twisting Injuries: Running and suddenly changing direction or getting their foot caught can cause spiral fractures (especially in the tibia).
• Low-impact Trauma: Unlike adults, toddlers don’t need high-energy impacts to break a bone—simple missteps or minor falls can be enough.

3. Bone Growth Plates (Physes)

• Weaker Growth Plates: The growth plates (areas of cartilage where bone grows) are more vulnerable to injury because they are softer than fully ossified bone.
• Buckle Fractures: Instead of clean breaks, toddlers often get buckle or torus fractures, where the bone compresses rather than snaps.

4. Lack of Coordination & Protective Reflexes

• Poor Balance & Coordination: Since toddlers are still developing motor skills, they don’t always fall in ways that protect their limbs.
• Delayed Protective Reflexes: Unlike older children or adults, toddlers don’t instinctively brace themselves with their arms when falling, increasing their risk of leg fractures.

5. External Forces & Common Mechanisms of Injury

• Falls from a Height: Falling off furniture, beds, or playground equipment can cause long bone fractures.
• Getting Limbs Caught: Foot getting stuck while turning or falling can twist the tibia, leading to a spiral fracture.
• Direct Blows: Accidental bumps from play or minor collisions can result in greenstick or buckle fractures.

Key Takeaway

Toddler fractures happen because their bones are softer, their motor skills are still developing, and they engage in activities with a high risk of falls and twists. Fortunately, these fractures usually heal quickly and well with proper treatment.

Prevalence and Demographics

Prevalence & Demographics of Toddler Fractures

• Common Age Group: Typically occurs in children aged 1–3 years, with peak incidence around 2 years old when toddlers become more mobile.
• Gender: Seen slightly more commonly in boys than girls, likely due to differences in activity levels.
• Most Affected Bone: The tibia is the most commonly fractured bone in toddlers, accounting for around 70% of toddler fractures.
• Frequency: Toddler fractures represent a significant portion of paediatric fractures, but precise prevalence varies. Estimates suggest that spiral tibial fractures occur in about 1 in 1,000 children under 6 years old per year.
• Seasonal Trends: Higher incidence in warmer months when children are more active outdoors.
• Causes:
  • Falls while walking or running (most common)
  • Falls from low heights (e.g., furniture, playgrounds)
  • Twisting injuries from sudden movements

Toddler fractures are rarely associated with high-impact trauma, and they heal well with conservative management.

Access Ortho offers orthopaedic care for toddler fractures. If you are concerned your child has an injury, contact Access Ortho for a rapid appointment. 

Symptoms and Causes

Symptoms:

• Pain & Tenderness: Localised to the affected bone, often in the leg (tibia).
• Refusal to Bear Weight: A key sign, especially in tibial fractures—toddlers may limp or refuse to walk.
• Swelling & Bruising: Mild to moderate, usually without severe deformity.
• Irritability & Crying: Especially when the affected limb is touched or moved.
• Minimal Visible Signs: Fractures may not show obvious external injury, making diagnosis challenging.

Causes:

• Falls While Running or Walking: The most common cause, especially twisting injuries.
• Low-impact Trauma: Even minor falls or missteps can cause fractures due to toddlers’ softer bones.
• Twisting Injuries: Often seen in tibial fractures when the foot gets caught while turning.
• Falls from Heights: Such as off furniture or playground equipment, leading to femur or humerus fractures.
• Direct Blows: Less common but can occur from minor accidents or collisions.

Toddler fractures are usually low-energy injuries and heal well with proper care. Access Ortho offers orthopaedic rapid advice and care for toddler fractures.

Risk Factors

• Age (1–3 Years): Peak incidence due to increased mobility but underdeveloped coordination.
• Developing Motor Skills: Frequent falls while learning to walk, run, and climb.
• Bone Characteristics: Softer, more flexible bones with higher cartilage content make toddlers more prone to fractures.
• High Activity Levels: Running, jumping, and climbing increase the risk of falls and twisting injuries.
• Lack of Protective Reflexes: Toddlers don’t instinctively brace themselves when falling.
• Environmental Factors: Slippery floors, uneven surfaces, and unsecured furniture can contribute to falls.
• Seasonal Influence: More fractures occur in warmer months due to increased outdoor play.
• Parental Supervision: Reduced supervision or unsafe play areas may increase injury risk.

Most toddler fractures result from low-impact trauma and heal well with conservative treatment.

Complications

• Delayed Diagnosis: Subtle fractures may not be immediately visible on X-rays, leading to delayed treatment. These fractures are often missed in the emergency department; therefore, seeking orthopaedic advice is essential. 
• Improper Healing (Malunion): Rare, but misalignment can occur if not properly immobilised.
• Growth Plate Involvement: If a fracture affects the growth plate, it may impact bone growth, though this is uncommon in typical toddler fractures.
• Re-fracture: Bones may be temporarily weaker after healing, increasing the risk of another fracture.
• Pain & Stiffness: Mild discomfort or temporary stiffness may persist after cast removal but usually resolves with movement.
• Psychological Impact: Some toddlers may be hesitant to walk again after healing, but this typically improves with time.

Most toddler fractures heal without long-term issues, especially with early diagnosis and proper management. It is important to get orthopaedic care for your child if they have injured themselves to minimise the risk of complications. Access Ortho offers rapid access to orthopaedic specialists for acute injuries. 

Diagnosis and Assessment

Diagnosing toddler fractures can be challenging because symptoms may be subtle, and initial X-rays might not always show clear fractures. A thorough history, clinical examination and imaging are essential for accurate diagnosis.

Diagnostic Process

1. Clinical History

• Gather details about how the injury occurred (e.g., fall, twisting motion).
• Ask about any previous similar injuries.
• Consider non-accidental trauma if the history is inconsistent with the injury.

2. Physical Examination

• Check for swelling, bruising, or tenderness along the affected bone.
• Assess for deformity, though most toddler fractures are non-displaced.

3. Observation of Behaviour

• Watch for reluctance to move the limb or signs of discomfort.
• Toddlers may be irritable or cry when the affected area is touched.

4. Pain Response Assessment

• Gentle palpation of the suspected fracture site to assess for localised pain.
• Look for guarding or withdrawal of the limb when touched.

5. Weight-Bearing Evaluation

• Check if the child refuses to walk or limps when attempting to bear weight.
• A refusal to bear weight is a strong indicator of a lower limb fracture.

6. Gait Analysis

• Assess for an abnormal walking pattern (e.g., limping, favouring one leg).
• Observe if the child avoids putting pressure on the affected leg.

Diagnostic Imaging

1. X-rays (Multiple Views)

• First-line imaging to confirm fractures.
• AP (anteroposterior), lateral, and oblique views help detect subtle fractures.
• Initial X-rays may appear normal; follow-up imaging may be required.

2. Advanced Imaging (If Needed)

• Ultrasound: Can detect fractures when X-rays are inconclusive.
• MRI or CT Scan: Used for complex or suspected growth plate injuries.

3. Follow-up Imaging

• Repeat X-rays after 7–10 days if initial imaging is inconclusive.
• Healing signs (such as callus formation) confirm the presence of a fracture.

4. Growth Plate Assessment

• It is important to check for physeal (growth plate) injuries, which can affect bone growth.

5. Healing Monitoring

• Ensures proper bone alignment and adequate callus formation.
• It helps determine when it’s safe to remove a cast or splint.

6. Comparative Views

• X-rays of the opposite limb may be taken for comparison, especially if findings are subtle.

A combination of clinical assessment and imaging ensures an accurate diagnosis of toddler fractures. If X-rays are normal but symptoms persist, follow-up imaging is crucial to detect fractures that may become visible later. The orthopaedic team at Access Ortho will provide a thorough examination and treatment plan and provide orthopaedic follow-up care. 

Special Considerations

1. Age-Appropriate Care

• Use child-friendly language and reassurance to reduce anxiety.
• Gentle handling and minimally invasive treatment whenever possible.

2. Pain Management

• Paracetamol or ibuprofen for pain relief.
• Avoid strong painkillers unless absolutely necessary.
• Encourage gentle movement to prevent stiffness.

3. Mobility Support

• Provide lightweight casts or splints for comfort and ease of movement.
• Use strollers or carrying aids if the child cannot bear weight.

4. Family Education

• Teach parents about signs of healing and when to seek follow-up care.
• Explain how to manage casts, swelling, and mobility restrictions at home.

5. Developmental Impact

• Ensure the child continues age-appropriate play and activities to prevent regression.
• Monitor for delayed walking or mobility issues after healing.

6. Psychological Support

• Address fear of movement after healing, as some toddlers may hesitate to walk again.
• Reassure parents and provide emotional support for both child and family.

Most toddler fractures heal quickly; Access Ortho will provide age-appropriate care and family involvement, which are crucial for a smooth recovery.

Management and Treatment

1. Immobilisation Techniques

• Most toddler fractures heal well with minimal immobilisation.
• Splints, casts, or walking boots may be used depending on fracture severity.

2. Cast Application

• Short leg casts for tibial fractures to stabilise the bone.
• Long leg casts for more severe fractures (e.g., femur).
• Plaster or fibreglass materials are used for lightweight support.

3. Boot Options

• Walking boots may be an alternative for stable fractures, allowing easier mobility.
• Preferred for minor or non-displaced fractures to avoid unnecessary immobilisation.

4. Pain Control

• Paracetamol or ibuprofen for pain relief.
• Avoid opioids unless severe pain is present.

5. Activity Modification

• Encourage limited weight-bearing as needed.
• Avoid high-impact activities until the fracture is fully healed.

6. Monitoring Protocols

• Follow-up X-rays to check bone healing and alignment.
• Watch for signs of delayed healing or complications.
• Gradual return to normal activity once cleared by a doctor.

Most toddler fractures heal within 3–4 weeks, with excellent outcomes when managed properly. Access Ortho provides orthopaedic care for people of all ages with suspected or known fractures, sprains, and strains. 

Prevention

• Supervise Play: Keep an eye on toddlers, especially on stairs, playgrounds, and uneven surfaces.
• Childproof the Environment: Use safety gates, secure furniture, and remove tripping hazards.
• Encourage Safe Play: Teach children to avoid running on slippery surfaces or jumping from heights.
• Proper Footwear: Ensure toddlers wear well-fitted, non-slip shoes for stability.
• Nutrition for Bone Health: Provide calcium- and vitamin D-rich foods to support strong bones.
• Avoid Baby Walkers: These can increase the risk of falls and fractures.

While minor falls are inevitable, a safe environment and good supervision can reduce the risk of toddler fractures.

Recovery and Prognosis for Toddler Fractures

Recovery Timeline & Healing Phases

• Initial Management: Immediate care involves pain relief and immobilisation to stabilise the fracture.
• Immobilisation Period: Typically lasts 3–4 weeks, depending on fracture severity. Casts or boots are commonly used during this time.
• Return to Walking: Toddlers may begin to walk again after the cast is removed, but this varies depending on the fracture’s location and severity.
• Activity Progression: Light activities may be resumed after 3–4 weeks, with more intense activities reintroduced gradually.
• Full Recovery: Most toddlers recover fully within 4–6 weeks, with bones strengthening and mobility returning to normal.

Developmental Impact & Considerations

• Walking Progression: Some toddlers may be hesitant to walk initially after healing, but confidence typically returns with encouragement.
• Confidence Rebuilding: Psychological support may be needed to rebuild confidence, especially if the child has developed a fear of falling.
• Physiotherapy: Physiotherapy is rarely required but may be considered for cases with delayed movement or weakness.
• Activity Resumption: Most children resume regular play and physical activity once the bone has healed.
• Long-term Outcomes: Toddler fractures usually have excellent long-term outcomes, with no lasting impact on bone growth or development if managed properly.

Overall, toddler fractures tend to heal well, and full recovery is expected with appropriate care and follow-up.

Where To Get Help For Toddler Fractures.

Fracture clinics / Urgent Care / Emergency Department / GP?

Access Ortho, a private fracture clinic, offers a better alternative to GP visits, emergency departments (ED), or urgent care by providing specialised, faster, and more affordable treatment for fractures, sprains, and dislocations.

Access Ortho provides excellent care for children and adults of all ages with fractures, sprains, or dislocations. Here’s how they can assist:

• Rapid Appointments: Immediate access to expert care, avoiding long wait times at emergency departments (ED) or general practitioners (GPs).
• Immediate Orthopaedic Advice: Receive expert advice from specialists in fracture management, ensuring timely and accurate diagnosis.
• Specialisation in Fractures: Focused expertise in treating fractures, ensuring your child or yourself gets the most appropriate care.
• Affordable Care: It is more cost-effective and efficient than visiting an ED or GP, and it provides accessible treatment and ongoing follow-up care.
• Radiology Services: Nearby radiology services are available for quick and accurate imaging to assess the injury.
• No Referral Needed: No referral is needed to access treatment, making it easy and convenient for families and individuals.
• Assessment Without Confirmed Fracture: You can visit even if unsure about a fracture, allowing for rapid assessment and early intervention.
• Minimising Complications: Quick assessments help minimise complications and ensure proper healing, reducing the risk of long-term issues.

Frequently Asked Questions

How do I know if my toddler has a fracture?

Common signs include pain, swelling, bruising, or limping. If your toddler refuses to walk or bear weight on the affected limb, it may indicate a fracture. Consult a medical provider for an assessment and diagnosis.

Why is my child refusing to walk?

There can be several reasons why a child may refuse to walk, one possibility being a toddler fracture. In some cases, the fracture may occur without a noticeable trauma, making it difficult to identify the exact cause. However, if your child suddenly refuses to walk, it’s important to seek medical attention to ensure their well-being.

Will my child need a cast?

It depends on the type and location of the fracture. Minor fractures may only need a splint or boot, while more significant fractures may require a cast for immobilisation and proper healing.

How long does healing take?

Most toddler fractures heal in 3–4 weeks. However, the exact time depends on the type of fracture and the child’s age, with full recovery generally occurring within 4–6 weeks.

Can my child walk during recovery?

Initially, your child may need to avoid weight-bearing on the affected limb. Once the fracture starts healing, they can gradually begin walking with the approval of a healthcare professional.

What pain relief is safe?

Paracetamol or ibuprofen are safe and effective for managing pain in toddlers. Always consult with a medical provider before giving any medication to ensure it’s appropriate for your child’s age and condition.

When should I worry?

If there are signs of severe pain, numbness, lack of circulation, or persistent difficulty moving the limb, seek immediate medical attention. If the fracture doesn’t seem to be healing, further assessment may be needed.

Will this affect future development?

With proper treatment, most toddler fractures do not affect future development. However, if the growth plate is involved, there is a small risk of affecting bone growth. Early intervention helps prevent complications.

How can I keep my child comfortable?

• Keep the affected limb elevated and comfortable to reduce swelling.
• Use cold packs for swelling and ensure your child is distracted with activities that don’t stress the injury.

What activities are safe during recovery?

Avoid high-impact activities like running or jumping. However, gentle activities like reading, arts and crafts, or light play are good to keep them engaged while recovering.

When can normal play resume?

Normal play can typically resume after 4–6 weeks, depending on the healing progress. Ensure the child’s mobility and strength are back to normal before resuming active play, and consult your healthcare provider for approval.