Toddlers Fractures - Cast Versus Removable Boot
Toddler's Fracture
About this trial
This is an interventional treatment trial for Toddler's Fracture focused on measuring Cast, Removable device/boot, Immobilization strategy, Emergency Department
Eligibility Criteria
Inclusion Criteria:
- Otherwise healthy, independently weight-bearing children aged 9 months to 4 years
- Present to the ED at SickKids, LHSC or CHU Sainte-Justine within five days of a lower extremity injury
- Diagnosed clinically and radiographically with an accidental TF will be eligible for enrolment
Exclusion Criteria:
- Children at risk for pathological fractures (Appendix 1) or those with chronic conditions (arthritis or neuromuscular disorders) since these children have different management requirements and potentially different pain and recovery timelines
- Children with multi-limb injuries
- Children with neuromotor deficits such that assessment of recovery or pain is confounded by the deficits
- Children whose parents/guardians who are unable to provide consent or complete follow-up procedures due to an insurmountable language barrier, or no access to a phone or electronic mail
- Children with diagnostic uncertainty of a TF (e.g. occult TF) or those whose TF might be the result of non-accidental injury
Sites / Locations
- The Hospital for Sick ChildrenRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Fiberglass above-knee walking cast (AKWC)
Landmark Pediatric Walker Boot (LPWB)
The standard treatment arm will be a posterior splint placed in the ED by the ED clinical team (nurse/physician) and then a fiberglass AKWC to be placed ideally within 72 hours in the fracture clinic. This AKWC will be in place for 3 weeks, which is currently the most common strategy to manage TF.
The Landmark Pediatric Walker Boot (LPWB) will be placed in the ED and will be kept on for a minimum of one week, and then for a duration dictated by the patient's comfort.