Question
A 2 year old boy refuses to bear weight on his left leg after a twisting fall from a slide.
- Describe the radiograph and the diagnosis.
- What is your differential diagnosis and when would you be concerned about non-accidental injury?
- Outline management.
Answer
Radiograph
- Undisplaced spiral fracture of the distal tibial shaft with an intact fibula
- Toddler fracture
- Children aged 9 months to 3 years
- Radiographs may be normal at first, periosteal reaction appears at 7 to 10 days
Differential diagnosis
- Septic arthritis of the hip or knee and osteomyelitis
- Transient synovitis
- Discitis
- Leukaemia
- Calcaneal or cuboid fractures
Concern for non-accidental injury
- Child not yet walking
- Inconsistent or changing history
- Delay in presentation
- Other injuries, bruising or metaphyseal corner fractures
- Skeletal survey and child protection referral when concerned
Management
- Above or below knee walking cast or boot for 3 to 4 weeks
- Allow weight bearing
- Union is reliable
- Repeat radiographs only if the diagnosis is uncertain
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.