Is above-knee cast better than below knee cast for the management of presumed toddler's fracture?

Report By: Dr Waleed Safdar - SHO Paediatrics A&E
Search checked by Dr Catherine Emma Nunn - ST2 Paediatrics
Institution: Nottingham University Hospitals NHS Trust
Date Submitted: 26th June 2010
Last Modified: 26th June 2010
Status: Blue (submitted but not checked)

Three Part Question

In [a toddler, not weight bearing after a minor injury and xrays of the tibia not demonstrating any fracture], is [above-knee plaster cast better than below-knee] for [presmued toddler's fracture]

Clinical Scenario

2 years old boy presented to A&E after a fall and was not weight bearing since. The clinical examintation revealed some tenderness at the junction of middle and lower 1/3 of anterior aspect of tibia. xrays did not reveal any fracture of tibia or fibula. Would you treat him in above-knee or below-knee cast for presumed toddler's fracture?

Search Strategy

Medline Pubmed

toddlers fracture, toddler's fracture, toddlers, above-knee cast, below-knee cast

Search Outcome

72 papers were found, none of which were relevant.

Comment(s)

There is no literature providing evidence on the best treatment of toddler's fracture.

Clinical Bottom Line

There is no evidence available to determine that above-knee plaster cast is better than the below knee. Anecdotally both methods have been used with success, so clinical practice should follow the local guidelines. The comfort of the patient must be considered.