extremity may be immobilized in a posterior long leg splint with a plan for postdischarge pain control and outpatient follow-up with orthopedics These fractures are rarely associated with delayed union or nonunion For open fractures, ipsilateral femur fractures, or any concern for compartment syndrome, orthopedics should be consulted emergently for open treatment Athletes older than 10 years may also sustain stress fractures of the tibia (most commonly in the proximal third) that typically present with a history of insidious leg pain that worsens with activity Initial radiographs may be normal with radiographic changes becoming apparent about weeks after symptoms Treatment is with activity modification and a walking boot for to weeks In paraplegic children, tibia and fibula fractures may present similarly to infection, with warmth and swelling over the lower leg Fractures in these children are treated conservatively with splints or casts for to weeks and orthopedic follow-up Toddler’s Fractures Originally, a toddler’s fracture referred to an oblique nondisplaced fracture of the distal tibia in children to 36 months old, but now this term is used more loosely to describe other lower extremity fractures sustained in this age group The history typically is that of a minor fall or there may be no history of trauma at all The physical examination may initially appear normal at rest, or there may be subtle findings of warmth or tenderness of the tibia and/or fibula The child usually does not appear to be in pain when at rest, but may cry with manipulation of the injured extremity or when he/she tries to put weight on the lower extremity Most often, the child refuses to bear any weight on the injured extremity and will only stand on the uninjured extremity Radiographs may appear normal or may demonstrate a spiral or oblique fracture extending downward and medial through the distal third of the tibia ( Fig 111.49 ) This may be visualized on anteroposterior or lateral views, although internal oblique projections may also be useful The extremity should be immobilized with a short leg splint or walking boot, and the patient should be referred to outpatient orthopedic follow-up If radiographs are negative, the child may be discharged home with primary care or orthopedic follow-up X-rays after 10 days may demonstrate subperiosteal new bone formation or enough sclerosis to make the fracture visible If no fracture is identified at this time, continued immobilization is not usually necessary Injuries of the Ankle and Foot Injuries of the Ankle