Classic metaphyseal lesion following external cephalic version and cesarean section

Lysack, John T.; Soboleski, Don

doi:10.1007/s00247-003-0914-9

Cited by 30 publications

(12 citation statements)

References 10 publications

(14 reference statements)

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“…Four infants suffered injuries shortly after cesarean delivery that reportedly resembled classic metaphyseal lesions [20,21]. The radiographs depicted in these reports, however, did not resemble classic metaphyseal lesions but rather appeared to represent either epiphysiolysis, with or without prominent perichondrial rings (Fig.…”

Section: Lack Of Replication and Confirmation Studiesmentioning

confidence: 93%

A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?

Ayoub

Hyman

Cohen

et al. 2014

American Journal of Roentgenology

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trauma. These metaphyseal abnormalities were identified from postmortem radiography and correlated with microscopy. The authors concluded the metaphyseal alterations represented partial or complete planar microfractures that transected the primary spongiosa adjacent to the growth plate. These microfractures usually resembled a "bucket-handle" or a "corner fracture," depending on the angulation of the x-ray beam relative to the true long axis of the extremity. These injuries are in distinction to the well-recognized SalterHarris type II injuries that are also commonly referred to as "corner" fractures.Recent case series have reported the presence of infantile rickets in young infants being evaluated for unexplained fractures mim- AJR 2014; 202:185-196 OBJECTIVE. The purpose of this study was to review the hypothesis that classic metaphyseal lesions represent traumatic changes in abused infants and compare these lesions with healing rickets. A Critical Pe d i a t r ic I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Using a PubMed search, a multidisciplinary team reviewed studies that reported the histopathologic correlation of classic metaphyseal lesions. Selective studies of growth plate injury and rickets were cross-referenced.RESULTS. Nine identified classic metaphyseal lesion studies were performed by the same principal investigator. Control subjects were inadequate. Details of abuse determination and metabolic bone disease exclusion were lacking. The presence of only a single radiology reviewer prevented establishment of interobserver variability. Microscopy was performed by two researchers who were not pathologists. Classic metaphyseal lesions have not been experimentally reproduced and are unrecognized in the accidental trauma literature. The proposed primary spongiosa location is inconsistent with the variable radiographic appearances. Classic metaphyseal lesions were not differentiated from tissue processing artifacts. Bleeding and callus were uncommon in spite of the vascular nature of the metaphysis. The conclusion that excessive hypertrophic chondrocytes secondary to vascular disruption were indicative of fracture healing contradicts the paucity of bleeding, callus, and periosteal reaction. Several similarities exist between classic metaphyseal lesions and healing rickets, including excessive hypertrophic chondrocytes. "Bucket-handle" and "corner fracture" classic metaphyseal lesions resemble healing rickets within the growth plate and the perichondrial ring, respectively. The age of presentation was more typical of bone fragility disorders, including rickets, than reported in prior child abuse series.CONCLUSION. The hypothesis that classic metaphyseal lesions are secondary to child abuse is poorly supported. Their histologic and radiographic features are similar to healing infantile rickets. Until classic metaphyseal lesions are experimentally replicated and independently validated, their traumatic origin remains unsubstantiated.Ayoub et al.

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Section: Lack Of Replication and Confirmation Studiesmentioning

confidence: 93%

A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?

Ayoub

Hyman

Cohen

et al. 2014

American Journal of Roentgenology

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“…Fractures of the mandible, epiphyseal fractures and classic metaphyseal corner fractures have also been reported, but are less common [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Birth-related mid-posterior rib fractures in neonates: a report of three cases (and a possible fourth case) and a review of the literature

2008

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Background Posterior rib fractures in young children have a high positive predictive value for non-accidental injury (NAI). Combined data of five studies on birth trauma (115,756 live births) showed no cases of rib fractures resulting from birth trauma. There have, however, been sporadic cases reported in the literature. Objective We present three neonates with both posterior rib fractures and ipsilateral clavicular fractures resulting from birth trauma. A review of the literature is also presented. The common denominator and a possible mechanical aetiology are discussed.

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“… Levering, bending or direct impact forces to long bones cause greenstick, horizontal and oblique fractures of long bones. Torsional forces cause spiral fractures of long bones. Chest encirclement and chest compression cause posterior (paravertebral) rib fractures, between the head and tubercle of the rib 12 Torsional and traction forces (pulling and twisting actions) cause distal metaphyseal fractures at the end of long bones (adjacent to the growth plate) in infants 13 . The term classic metaphyseal fracture was used by Kleinman to describe these fractures that histologically occur through the primary spongiosa in the subepiphyseal region of the metaphysis 14 …”

Section: Fracturesmentioning

confidence: 99%

“…Torsional and traction forces (pulling and twisting actions) cause distal metaphyseal fractures at the end of long bones (adjacent to the growth plate) in infants 13 . The term classic metaphyseal fracture was used by Kleinman to describe these fractures that histologically occur through the primary spongiosa in the subepiphyseal region of the metaphysis 14 …”

Section: Fracturesmentioning

confidence: 99%

Suspicious childhood injury: Formulation of forensic opinion

Skellern

Donald

2011

J Paediatrics Child Health

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Abstract:Child protection paediatricians have a role as forensic experts in the context of suspicious childhood injury. The task of forensic evaluation of suspicious injury is to reach a conclusion to support legal proceedings. For each injury, one of four conclusions should be reached: 1 The injury has been caused by another person and is considered to have been inflicted. 2 The injury is adequately explained by the circumstances of the injury event provided (by the carer or other witnesses). 3 The injury is self-inflicted -has been caused by the child's own behaviour as a result of normal childhood activity (with no other person actively involved). 4 The mechanism or sequence of events leading to the injury remains indeterminate or unclear.An additional consideration is determining the extent to which an injury incident was foreseeable and therefore preventable, to form an opinion on whether lack of care (neglect) is involved. Opinions reflect a body of knowledge in forensic and medical literature of known mechanisms of injury including biomechanical aspects of tissue injury in trauma scenarios. Limitations in using research documenting injury type and prevalence at different developmental stages is discussed and in particular, the application of such research to support a conclusion that the injury must have been inflicted. Emerging recognition of research documenting injuries that overlap with those found in populations of children thought to have been physically assaulted creates some doubt on previous opinions regarding exclusivity of certain findings in children definitively indicating 'abuse'. Forensic paediatricians should remain objective, limit their opinions to what can be confidently stated and exercise caution where reasonable doubt exists and avoid speculation.

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Classic metaphyseal lesion following external cephalic version and cesarean section

Cited by 30 publications

References 10 publications

A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?

A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?

Birth-related mid-posterior rib fractures in neonates: a report of three cases (and a possible fourth case) and a review of the literature

Suspicious childhood injury: Formulation of forensic opinion

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