Objective: To further define and describe the spectrum of presentations for accidental spiral tibial fractures of childhood.

Design: A retrospective review.

Methods: Children 8 years of age or younger who had sustained a tibial fracture within the last five or ten years were collected from the patient populations of two large tertiary medical centers in Southern California, Riverside General Hospital (RGH) and Loma Linda University Medical Center (LLUMC). A total of 189 tibial fractures were documented from both locations. Of the 189 patients, the 55 children with isolated spiral tibial fractures and no criteria for exclusion were selected for further review and analysis. These patients were reviewed for age at time of injury, gender, specific extremity involved, mechanism of injury, fracture location, degree of displacement, and whether child protective services involvement occurred.

Results: Patients with isolated spiral tibial fractures ranged in ages from 12 months to 94 months (7 years 10 months). The mean age was 50.7 months. Eighteen (32.7%) of the patients were less than or equal to 36 months of age. No patient was under one year of age. Males (38/55 or 69%) sustained the fracture slightly more frequently than females. The right extremity was injured slightly less frequently (45.5%) than the left extremity (54.5%). Overall, the lower two thirds of the tibia contained the fracture in 95% of the injuries. Displacement of the fracture segments was most frequently none or minimal. While Child Protective Service referrals or investigations were not accomplished on the majority of the children, no injury was confirmed to have occurred as a result of non-accidental trauma.

Conclusion: Isolated spiral tibial fractures are a common injury of children less than 8 years of age and are most frequently accidental. The original description of a distinct clinical entity matching the original definition of the toddler's fracture does not appear to exist. Instead, the previously defined toddler's fracture is simply part of a spectrum of presentations of childhood accidental spiral tibial, or CAST, fractures. Consequently, our findings further support new nomenclature suggested for this fracture (1, 2).