It’s the way you (don’t) walk: Fractures of the tibia and fibula

Case presentation

A 7-year-old male is brought in for evaluation. A few hours prior to presentation, he was jumping up and down on a couch when he jumped off, landing on his right leg. He states he heard a “pop” and then began to experience pain and difficulty with ambulation secondary to the pain. There is no reported loss of consciousness; he denies neck pain, back pain, hip pain, weakness, numbness, or other symptoms.

His physical examination reveals an afebrile child who is complaining of right lower leg pain. His heart rate is 91 beats per minute, respiratory rate is 20 breaths per minute, and blood pressure is 118/62 mm Hg. There is mild swelling to the anterior surface of the midshaft of the right tibia and fibula. There is no obvious deformity. There is no abrasion, laceration, or ecchymoses. His anterior tibial and posterior tibial pulses are intact. He has no pain, swelling, or tenderness to the ipsilateral hip, knee, ankle, or foot. He has normal range of motion at these joints. He is grossly neurologically intact. There is no back tenderness, crepitus, step-off, or deformity.

Imaging considerations