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The fracture results from a twisting or torque force on the tibia which occurs during one of the frequent accidental falls that are so common in this age group.
In some cases, the fracture may not be visible at all on the initial radiographs, and only soft tissue swelling may be evident.
When a toddler's fracture is strongly suspected, but not visible on radiographs, a radionuclide bone scan may be helpful to confirm the abnormality.
Alternatively, the leg may be immobilized and repeat follow-up radiographs may show the fracture more clearly.

Such recognition will avoid unnecessary and unjustified concern about the possibility of nonaccidental trauma. When the fracture is not initially visualized, osteomyelitis could be considered but should be distinguished by other clinical evidence of infection.
These are more easily recognized by radionuclide bone scanning, and are usually not visible on radiographs until healing results in a zone of sclerosis. These injuries usually are fairly self-limited, with symptoms resolving spontaneously; the frequent, minor accidental injuries of childhood are presumably the etiology of these fractures as well.

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