Spiral fracture of the tibia (not displaced) in a child age 9-36 months. Fracture may have occurred in minor fall or twisting fall, often unwitnessed. The toddler is often unable to articulate the details of the injury. Characterized by inability to bear weight that appears as a limp (irregular gait or limited range of motion) or refusal to be examined. Child may be in no acute distress, or may be irritable, crying, and unable to walk or crawl with the same proficiency as prior to the injury.

The diagnosis is often made when faint hairline fracture is noted on plain radiographs of the tibia. However, the fracture may not show on plain radiographs until about 2 weeks after the injury as healing begins. In situations with a negative plain film, a clinical diagnosis is often made based on compatible history and exam. A bone scan or MRI may also be used to confirm the diagnosis in more complex cases or atypical presentations.

Suspect toddler fractures should be immobilized with a long leg splint and referred to a pediatric orthopedist for casting.