Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?

OBJECTIVE: The majority of uncomplicated toddler fractures of the tibia (toddler's fractures) do not need an orthopaedic surgeon's intervention or follow-up. However, inexperienced emergency room physicians, general practitioners and orthopaedic trainees and surgeons understandably defer to a cautious approach of referral and subsequent frequent clinical and radiographic follow-up. An evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system.

PATIENTS AND METHODS: A retrospective analysis of patients who presented for management of toddler's fractures to The Hospital for Sick Children (SickKids) was performed.

RESULTS: A total of 184 (113 boys, 72 girls) patients, of a mean age of 1.99 (range: 0.2-3.9) years, were included for review. The included patients had attended 2.00±1.0 clinic visits and had had 5.86±2.7 radiographs taken on average. No complications such as cast injuries, nonunion, refracture or subsequent deformity needing assessment or intervention were identified.

CONCLUSION: Toddler's fractures do not require routine orthopaedic surgeon assessment, intervention or follow-up. If diagnosed and managed correctly at initial presentation, patients with toddler's fractures may be discharged safely without the need for further clinician contact. We developed a toddler's fracture clinical care pathway to reduce unnecessary orthopaedic surgeon referral and clinical and radiographic follow-up, thereby decreasing radiation exposure and costs to families and the healthcare system without risking patient outcomes.