![]() The angulation is then gently corrected, the first cut being held open with a piece of cork (avoid skin pressure), while the open wedge is closed. An appropriate half-wedge is then removed from the convex side, not quite meeting the first cut, but leaving a 1cm. Make a half-circumferential cut in the cast on the concave side of the angulation. Wedging is safer if sufficient padding is applied during the original cast application. Wedging needs to be delayed till the plaster cast is completely hardened (day 3 or 4), or later. Small angular malalignments can be corrected by wedging without changing the plaster. At this point it may be appropriate to begin progressive weight bearing. Once the fracture is likely to be sticky (approximately 6 weeks), remove the cast and pins and apply a new cast. It can later (3-4 weeks) be shortened to a below knee plaster, still maintaining the pins incorporated in the plaster. Initially the cast should be extended above the knee for better stability and comfort. This procedure is usually done under general or regional anesthesia. Once hard, the cast functions as the frame of an external fixator, using the transfixion pins to maintain fracture alignment. Then, with the fracture held reduced, POP is applied, incorporating the pins as described. Traction, rotation, and angulation of the pins can be used to correct deformities. Note: The transfixion pins can be used as reduction aids. Excessive pin length can be removed with a pin cutter, but at least 2cm or so of pin should be incorporated in the plaster, both medially and laterally. Be careful not to pull the plaster tightly from one end of the pin to the other, since there should be no extra pressure on the skin. The cast is applied, by rolling plaster smoothly up to and incorporating the pin on each side with a thick cuff of plaster (2 cm) around each pin. Some antibacterial ointment and a sterile dressing are applied over the pin site. With a small incision no sutures are necessary. ![]() Incise the skin if necessary to release it. With either form of movement restriction, the children can walk on the injured extremity as their pain allows.Make sure that the skin is not under tension from the pin. In some very small children, treatment for this fracture may include a long leg cast because the boots are too small and shorter casts can slide off of small children. Boots are nice in that they provide support to the fracture, allow the children to walk, and can be removed for bathing. This also allows them to heal quickly.ĭepending on the size of the child, most of these fractures are treated by placing the child in a walking boot. Because of this, toddler’s fractures are very stable and do not move out of position. With toddler’s fractures, the calcified, hard portion of the bone is fractured but the thick periosteum is intact. In children’s bones, there is a very thick wrapper surrounding the bone called the periosteum. Even if the X-rays are normal initially, new bone can usually be seen on X-rays that are repeated 2 weeks after the injury as the body heals the fracture. Usually, there is no swelling or bruising in the area. The physician may be highly suspicious that a fracture exists even if an X-ray is normal but the child has tenderness over the lower leg and/or refuses to put weight on the affected side. How is a Toddler's Fracture Diagnosed?Ī toddler’s fracture may be diagnosed with X-rays, but often the X-rays are normal. The child usually cries and refuses to bear weight on the injured side. The injury or twisting may be minor and go unnoticed. It usually happens because of a twisting injury to the leg. A toddler’s fracture occurs in children 1 to 3 years old. A toddler’s fracture is a spiral fracture of the tibia that is perfectly or nearly perfectly aligned.
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