SplintER Series: One Big Bounce

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

What is your diagnosis?

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

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 (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

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 [1]. They can follow up with either orthopedics or sports medicine as an outpatient in 1-2 weeks.