Management of Toddler's Fractures: A Systematic Review

Pediatr Emerg Care. 2020 Jan 20. doi: 10.1097/PEC.0000000000002005. Online ahead of print.


Objectives: The aim of this study was to examine and compare the efficacy of external fixation strategies of toddler's fracture (TF) in acute care settings. Specifically, we aim to identify whether immobilization optimizes clinical outcomes for patients (based on immobilization duration, time to weight-bear/ambulate, and associated complications) compared with nonimmobilization, with a systematic review.

Study design: After PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 2 independent reviewers searched electronic databases OVID Medline, Embase, and CINAHL for studies evaluating the health outcomes of various treatment methods for TF (1937-2019). The studies were chosen based on specific inclusion criteria. The 2 reviewers were looking for primary research articles that assessed health outcomes (such as immobilization duration, time to weight-bear/ambulate, and associated complications) of various treatment strategies for TF Fractures in acute care settings.

Results: A total of 2385 articles were initially screened, reviewed, and then narrowed down to 6 studies for an in-depth analysis. Among these 6 studies, 5 were retrospective chart reviews and 1 was a cross-sectional online survey. A total of 565 patients from the retrospective chart reviews and 153 physicians from the cross-sectional online survey were further analyzed. The current evidence shows that there was no significant difference in clinical outcomes (ie, time to weight-bear and immobilization duration) between immobilization and nonimmobilization.

Conclusions: Further large-scale prospective studies examining the clinical outcomes of TF management techniques should be conducted to establish a consistent standardized guideline for TF treatment across acute care settings.