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Toddler’s Fracture – CAM Walker Boot, Cast, or Nothing?

March 24, 2020

Written by Clay Smith

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This study was inconclusive, but provides assurance that treating children with confirmed or suspected toddler’s fracture (TF) in a controlled ankle motion (CAM) walker boot is safe and equally effective compared to casting.

Why does this matter?
Traditional treatment of a TF, or suspected TF, is an above the knee (AK) cast, but this is not often done in practice. The largest study of TF showed that a CAM walker boot is adequate and allows earlier weight bearing. All kids had good healing and return to weight-bearing at 4 weeks regardless of treatment modality. Do we need to do anything for TF?

That’s what I’m talkin’ a boot!
Six articles were found, 5 retrospective studies and one survey. Most were single-center chart reviews. The authors could not make conclusive recommendations that non-immobilization was safe based on this information. They did note that a, “majority of the studies suggest that TF can be managed conservatively with no initial immobilization or CAM boot.” It is important to note that casting is not benign. Skin breakdown was common in children who were immobilized in a cast; my best estimate based on these data was 3-26%. Although this study cannot provide conclusive management recommendations, when all these articles are considered together, I feel affirmed in my current practice, which is to place confirmed or suspected TFs in a CAM walker boot.

Management of Toddler’s Fractures: A Systematic Review. Pediatr Emerg Care. 2020 Jan 20. doi: 10.1097/PEC.0000000000002005. [Epub ahead of print]

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