Pediatrics Case 8 History/Physical

Many patients present after a fall with inability to bear weight. Because the child may be too young to report what happened, if unwitnessed, the presentation may simply be a toddler with a limp or refusing to bear weight. 

On physical exam, the leg may look normal externally, without appreciable swelling or bruising. There will often be tenderness to palpation over the distal tibia. Attempts to stress the tibia with gentle traction may reproduce pain when direct palpation is inconclusive. These maneuvers, however, may still not pinpoint the pain in the apprehensive crying child. The child will often refuse to bear weight.