This guideline is specific for the assessment and management of fractures of the lower leg (e.g. tibia and fibula)
Tibial shaft and/or distal third fractures are the commonest leg injury of all ages (approximately 1/3 of leg fractures in children)
Compartment syndrome is a potential complication, especially in high velocity injuries
Tibial shaft fractures are one of the most common long bone fractures in children
Toddler fractures are common in mobile children under 3 years old and tend to be stable fractures
The tibia and fibula are common sites for stress fractures in children aged 8 – 15 years. The proximal third of the tibia is most commonly affected. There is usually gradual onset pain and limp with minimal X-Ray findings and rest is the only treatment required.
In high velocity trauma, look for signs of compartment syndrome
Toddlers fracture may present with limp and minimal history of trauma
A common mechanism of injury for lower leg fractures is a fall resulting in a direct blow or a rotational force
Sports injuries and motor vehicle accidents are a common mechanism in older children
Toddlers fractures commonly occur with minimal trauma in the child who is learning to walk and trips over. The mechanism may be trivial and often no injury is recalled by the parents.
Consider non-accidental injury. Complete an Injury Proforma form for all children < 2 years (A3 sheet located in the Doctor’s offices)
Tibial shaft fractures will have localised swelling and tenderness with or without clinical deformity. The child will not weight bear on the injured leg.
Toddler fractures often have subtle physical findings with minimal swelling and tenderness. Toddlers will favour the injured leg and not want to weight bear. Carefully examine the hip, knee and ankle joints to exclude septic arthritis, other injury and other causes of limp.
Toddler fractures may have an initial normal X-Ray or appear as an incomplete, usually vertical or oblique, hairline crack in the distal tibia. It is typically seen in only one view. If the initial X-Ray is normal, follow up X-Rays 7-10 days later may show signs of periosteal reaction or healing.
Seek immediate Orthopaedic advice if there is neurovascular compromise or signs of compartment syndrome
Undisplaced fractures are managed in an above knee backslab
Consider other causes of limp in toddlers (such as septic joint and osteomyelitis) in suspected toddler fractures with a normal X-Ray