Most toddlers and infants are well protected from injury when they are in their proper car seat restraint. Car seats are designed to keep the toddler firmly within the device with limited movement at the time of impact. It’s clear that child safety seats do a lot to reduce morbidity and mortality in young children who use them properly.
Even so, injuries can occur. The most common injury seen in properly restrained toddlers and infants appears to be lower extremity fractures. This can happen in rear-facing car seats in which the infant is tall enough to have forces of the accident push the feet into the back seat. A loose car seat facing forward can lead to tibial and fibular fractures from the extended legs of the toddler hitting the back of the front seat or the dashboard if the child is in the front seat.
In one study, ten toddlers were properly restrained at the time the vehicle they were riding in was involved in a motor vehicle accident. Of the ten toddlers, four had sustained leg fractures, specifically tib/fib fractures. In two cases, the infant had sustained bilateral tib/fib fractures but had few of the obvious signs of a tibial and fibular injury. The results of the study indicated that doctors need a high index of suspicion for this type of fracture especially in toddlers and infants involved in motor vehicle accidents, even when restrained properly.
Typical symptoms in an infant with a tibial/fibular fracture are crying from pain and increased swelling of the lower leg. There can be increased crying with the movement of the lower leg and abrasions or ecchymosis (bruising) of the leg at the fracture site. An x-ray should be done of both legs to see where the fractures lie and an orthopedist should be consulted.
Fractures of the tibia can be transverse (across the bone) or spiral fractures. They can be non-displaced, partially displaced or completely displaced. The location can be low on the bone (distal) or higher up near the knee (proximal). These characteristics of the fracture determine whether or not the fracture needs to be repaired with surgery or can be treated with casting. Some experts say that those toddlers with spiral fractures or displacement of the fracture at more than fifty percent are at higher than average risk of nonunion of the fracture and should be treated with surgical intervention.
Fortunately, many tib/fib fractures in children can be treated with casting, and surgery is reserved only for cases where the fracture is not healing properly or in severe cases where the bones are not connected at all.
In children, the prognosis of a tibial/fibular fracture is quite good. There can be growth problems involving the affected leg, depending on what part of the leg is broken, but most children catch up with their growth to the point where they do not need to limp in order to get around. Age is most definitely in their favor.