• Jade Seguin, Daniel Brody, and Patricia Li.
• *Department of Pediatric Emergency Medicine,Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
• Can J Emerg Med. 2018 Sep 1; 20 (5): 739-745.

BackgroundTibial fractures are common in children less than 3 years old. The traditional management involves immobilization in an above knee cast for both confirmed (positive x-ray) and presumed (normal x-ray) toddler's fractures. This carries health care implications and causes unnecessary burden for patients and their families. There is a paucity of literature describing the ideal immobilization strategy for this injury.ObjectivesTo determine: 1) the variation between Canadian emergency departments in management of toddler's fractures; 2) the variation in management between confirmed and presumed toddler's fractures; 3) the association between demographic variables and immobilization strategies.MethodsThis was an email survey of all members of the Pediatric Emergency Research Canada network. The survey consisted of 2 clinical vignettes followed by multiple-choice questions.ResultsSurvey response rate was 73% (153/211). For confirmed toddler's fractures, 39% of physicians chose to immobilize with above knee circumferential cast, 27% with below knee circumferential cast and 20% with below knee splint. For presumed toddler's fractures, 44% of respondents chose to manage without casting, 22% with below knee splint and 14% with above knee circumferential cast. There was significant practice variation between Canadian pediatric emergency departments for both types of fractures and between the management of confirmed and presumed toddler's fractures.ConclusionsOur study is the first to identify nationwide variation in the management of toddler's fractures. This variation highlights the need for future research to compare the different management strategies to determine families' preferences and functional outcomes in children with these injuries.

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