The proposed mechanism involves shear stress and lack of displacement due to the periosteum that is relatively strong compared to the elastic bone in young children.

[2] Typical symptoms include pain, refusing to walk or bear weight and limping -bruising and deformity are absent.

On clinical examination, there can be warmth and swelling over the fracture area, as well as pain on bending the foot upwards (dorsiflexion).

Contrary to CAST fractures, non-accidental injury typically affect the upper two-thirds or midshaft of the tibia.

[4] In some cases, an internal oblique radiography and radionuclide imaging can add information to anterior-posterior and lateral views.