A 5-year-old boy presents with right leg pain and a limp. His parents report it started after he was bouncing on the trampoline with his older sibling but they did not notice any specific trauma. He has tenderness over his proximal shin with no obvious injury. You suspect a fracture and obtain x-rays of the right knee (Figure 1).

Figure 1. AP and Lateral x-rays of the right knee. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139

 

Transverse fracture of the proximal tibial metaphysis, otherwise known as trampoline fracture (Figure 2).

Figure 2. AP and Lateral x-rays. Note the Transverse fracture of the proximal tibial metaphysis, otherwise known as trampoline fracture (green arrows). Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 16139, annotations by author

This fracture typically occurs when a child is bounced by a larger individual on a trampoline or bouncy house (Figure 3). As the larger individual lands, the force of the springing surface travels through the child’s leg, creating an impact fracture [1].

  • PEARL: This fracture typically occurs in patients between the ages of 2-5 due to an immature skeleton and lack of coordination [1].

Figure 3. Illustration by Tabitha Ford, MD

This fracture pattern is typically minimally displaced, and patients should be placed in a long leg splint and made non weight bearing [1]. They can follow up with either orthopedics or 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 a risk factor.

 

Resources and References

Check out ALiEM’s Paucis Verbis cards to brush up on other can’t miss orthopedic injuries, and SplintER Series for more pediatric cases.

  1. G.A. Smith, B.J. Shields. Trampoline related injuries to children. Arch Ped Adoles Med, 152 (1998), pp. 694-699
Mark Hopkins, MD

Mark Hopkins, MD

Loma Linda University Health
Mark Hopkins, MD

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Alexander J. Tomesch, MD

Alexander J. Tomesch, MD

Primary Care Sports Medicine Fellow
Department of Orthopedic and Sports Medicine
University of Arizona - Tucson
Alexander J. Tomesch, MD

@DocTomesch

Emergency Medicine/Sports Medicine physician, Father, Husband, Sports Enthusiast, Craft Beer Lover, COVID HATER!
Alexander J. Tomesch, MD

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