Author: Mark Hopkins, MD
Peer-Reviewer: Alex Tomesch, MD
Final Editor: Alex Tomesch, MD
A 5 year old male presents with right leg pain and limp. Parents report it started after he was bouncing on the trampoline with his older sibling but deny any specific trauma. He has tenderness over his proximal shin with no obvious injury.
Image 1. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139
What is your diagnosis?
What is the typical mechanism of injury?
What is your disposition and management?
-- see below for answers --
What is your diagnosis?
Transverse fracture of the proximal tibial metaphysis, otherwise known as trampoline fracture.
Image 1 (AP) and 2 (lateral). Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139, annotations by author
What is the typical mechanism of injury?
This fracture typically occurs when a child is bounced by a larger individual on a trampoline or bouncy house (See Image 3). As the larger individual lands, the force of the springing surface travels through the child's leg, creating an impact fracture [1].
PEARL: Typical age is 2-5 due to an immature skeleton and lack of coordination [1]
Image 3. Illustration by Tabitha Ford, MD
What is your disposition and management?
This fracture pattern is typically minimally displaced, and patients should be placed in a long leg splint and made non weight bearing. They can follow up with orthopedics vs sports medicine as an outpatient in 1-2 weeks.
PEARL: If there is significant displacement, consult orthopedics and keep compartment syndrome in mind as tibial fractures are at high risk.
Resources
G.A. Smith, B.J. Shields. Trampoline related injuries to children. Arch Ped Adoles Med, 152 (1998), pp. 694-699
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