A silent crack

Key words: Toddler fracture, Diagnosis, Case report

The article reports the case of a three-year-old boy that was brought to the Emergency Unit because of fever and refusal to bear weight on the right leg in the last four days. Blood exams and X-ray scan of the leg were normal without other signs or symptoms on the remaining physical examination. The story led to the diagnosis of spiroid fracture, confirmed by a second X-ray scan of the leg. The spiroid fracture is a tibial shaft fracture and is a subtle and “silent” cause of pain and inability to bear weight in a child. Usually, a history of a minor trauma is the underlying issue: however the caregiver may be unaware of it or may dismiss it as unimportant. For this reason it can be untold on a first anamnesis, as it happened in the present case. Moreover, the fracture can be missed on a first X-ray scan in 13-43% of the cases. The paper points out that the toddler fracture is one of the most important causes of inability of bear weight in children between nine months and four years old and must be suspected if there is history of a twisting or rotational injury despite a negative X-ray scan. In most cases a second X-ray, in a different projection, should show the fracture.