Management of the Toddler's fracture with and without initial radiological evidence

Toddler's fracture (TF) occurs in young children after minor trauma. Clinical diagnosis can be challenging and initial radiological evidence may be lacking. The aim of this study was to compare the management and outcomes of clinically diagnosed TF patients with and without initial radiological evidence. A retrospective cohort study of patients aged between 9 and 36 months treated for TF in a Scottish Paediatric Emergency Department was conducted. Patients with a radiologically confirmed TF were more likely to be placed in a cast than those with a presumptive clinical TF diagnosis (92 vs. 47%; P<0.02). Overall cast duration and duration from follow-up to discharge from clinic were similar in both groups. There were no complications with management in or out of cast. The initial presumptive clinical diagnosis of TF may be as significant as that with radiological confirmation. Follow-up imaging is unlikely to affect management if the diagnosis remains clinically clear.