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Question: Ortho

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A 20 month old boy is brought in by his mother for refusal to bear weight on the right leg. She was at work all day and the child went to the park with his father, but no known trauma occurred. He has had no fever, URI symptoms, or rash. He was born full-term and has no significant past medical history. Physical exam of his right leg is unremarkable. AP and lateral X-rays are as shown. 

What is the next best step in management?

pemsou5_wp • June 28, 2022

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  1. Kelly June 30, 2022 - 11:48 pm Reply

    E) Place a long leg posterior splint and discharge with orthopedic follow-up
    The lateral view shows a subtle non-displaced oblique fracture line in the proximal tibia. The history and x-ray findings are typical for toddler’s fracture, which is a non-displaced spiral or oblique fracture of tibia in ambulatory toddlers. Children present with refusal to walk. The mechanism is a foot plant and twist motion, usually occurring in a ground level fall that may have been unwitnessed by adults. It is not uncommon for there to be few physical exam findings and no known history of trauma. Photo from

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