Pediatrics Case 8 Diagnosis

The diagnosis can be made clinically in a classic scenario and is often confirmed on X-ray by seeing a subtle lucency that signifies the oblique/spiral fracture. Sometimes the fracture may not be visible on initial imaging. An oblique view may detect additional cases.  If the child displays classic symptoms, the diagnosis can be presumed clinically, with repeat imaging recommended in 10-14 days.

A common conundrum is whether a lucent line in the distal tibia is a fracture or a nutrient vessel, as in the radiograph for this case.  Nutrient vessels tend to corticated, while acute fractures will not be.  Remember, though, that the ED diagnosis will be clinical in cases that are not confirmed by radiographs.