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Review Question - QID 721

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QID 721 (Type "721" in App Search)
A 23-month-old girl refuses to bear weight since falling on the playground yesterday. The child is afebrile and her WBC and erythrocyte sedimentation rate (ESR) are within normal limits. On physical exam the leg has no erythema, but does have mild tenderness along the distal tibial shaft. Plain radiographs are negative. What is the most appropriate management?

vitamin D and calcium levels

6%

118/1895

MRI of the pelvis

5%

86/1895

long leg cast

87%

1647/1895

chromosomal analysis

1%

12/1895

aspiration of the knee

1%

23/1895

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The clinical presentation is consistent with a toddler's fracture, which is treated with a long leg cast. Initial radiographs are often negative but follow-up radiographs may demonstrate a healing periosteal reaction.

According to Mashru et al in a review of tibia fractures, toddler's fractures are one of the most common injuries in the child younger than 2 years. They are non-displaced spiral fractures of the tibia caused by low-energy twists and falls. The treatment is application of a long leg cast for 3-4 weeks.

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