A twisting of the lower leg caused by a fall can result in this spiral fracture of the distal third of the tibia. Although it is most often seen in children just learning to walk, it may occur up to age 6. Examination of a frightened child may be difficult. Tenderness and swelling may be palpated at the fracture site. More often, the presentation is one of a limping child with no clear history of injury. In this setting, an x-ray of both the tibia and the femur should be obtained. The fracture may be subtle and visible on only one view. Sometimes the fracture is only seen during resorption and callus formation. Treatment involves a long leg cast for 2 to 4 weeks, with weight bearing as tolerated. Orthopedic consultation should be obtained.
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