Tibial fractures usually result from high force trauma
Stress fractures of the tibia result from repeated low force trauma
'Toddler's fracture' = Tibial spiral fracture in a toddler
Tibial stress fractures and toddler's fractures may not be visible on the initial X-ray - follow up may be necessary
High force impact is required to fracture the tibia. Injuries are often obvious both clinically and radiologically, but a careful check should be made for undisplaced fractures.
Occasionally a history of chronic tibial pain is due to a stress fracture. Stress injuries are due to repeated low force trauma to a normal bone - unlike a pathological fracture which is the result of minor injury to an abnormal bone.
Standard views
Anterior-Posterior (AP) and Lateral. Several images may be required to ensure at least 2 views covering the whole length of both bones.
Periosteal stress reaction are signs of stress injury (often not present on the initial X-ray)
History of chronic pain worsened by activity
Toddler's fracture
A toddler's fracture is a spiral tibial fracture seen in young children. This fracture is associated with a twisting injury, and may present with refusal to weight-bear. Often there is little or no displacement and the fracture line is very subtle. Some toddler's fractures are not visible on the initial X-rays but cause a periosteal stress reaction which becomes visible on follow up.
