Metaphyseal fractures mimicking abuse during treatment for clubfoot

Grayev, Allison; Boal, Danielle K.; Wallach, David M.; Segal, Lee S.

doi:10.1007/s002470100497

Cited by 64 publications

(21 citation statements)

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“…The distal femur and proximal tibia are the two areas most often involved, and excessive torsional or shearing forces have been proposed as the likely mechanism of injury [2]. CML of the distal tibia has been recently described following orthopedic maneuvers for the treatment of clubfoot, presumably as a result of the iatrogenic application of similar forces [6,7]. Since significant pulling and twisting forces are also necessary for certain obstetrical maneuvers, extremity fractures are a recognized but uncommon complication of breech extraction and cesarean section in particular [3,4].…”

Section: Discussionmentioning

confidence: 99%

Classic metaphyseal lesion following external cephalic version and cesarean section

Lysack

Soboleski

2003

Ped Radiol

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We report a case of an otherwise healthy neonate diagnosed at birth with a classic metaphyseal lesion of the proximal tibia following external cephalic version for frank breech presentation and a subsequent urgent cesarean section. Although the classic metaphyseal lesion is considered highly specific for infant abuse, this case demonstrates the importance of obtaining a history of obstetric trauma for neonates presenting to the imaging department for suspected non-accidental injury.

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Section: Discussionmentioning

confidence: 99%

Classic metaphyseal lesion following external cephalic version and cesarean section

Lysack

Soboleski

2003

Ped Radiol

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“…Grayev et al described metaphyseal fractures in children undergoing serial casting for club foot correction. 29 Occasionally developmental variants can be difficult to differentiate from fractures. The normal step off of the metaphyseal collar as it approaches the physis, metaphyseal spurs especially around the knee and wrist and metaphyseal fragmentation of the distal femur or proximal tibia associated with 4 week old premature baby (25 weeks gestation).…”

Section: Differential Diagnosismentioning

confidence: 99%

(iv) Imaging of non-accidental injury

Kraft

2011

Orthopaedics and Trauma

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“…31 Fractures resembling CMLs radiographically have been reported after breech delivery 32 and as a result of treatment of clubfoot. 33 Depending on the projection of the radiograph, CMLs can have the appearance of a corner or a buckethandle fracture. Acute injuries can …”

Section: Fractures With High Specificity For Abusementioning

confidence: 99%

Evaluating Children With Fractures for Child Physical Abuse

Peréz-Rosselló¹,

Levine²,

Hennrikus³

et al. 2014

Pediatrics

246

162

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Fractures are common injuries caused by child abuse. Although the consequences of failing to diagnose an abusive injury in a child can be grave, incorrectly diagnosing child abuse in a child whose fractures have another etiology can be distressing for a family. The aim of this report is to review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. This clinical report will aid physicians in developing an evidence-based differential diagnosis and performing the appropriate evaluation when assessing a child with fractures. Pediatrics 2014;133:e477-e489 INTRODUCTIONFractures are the second most common injury caused by child physical abuse; bruises are the most common injury. 1 Failure to identify an injury caused by child abuse and to intervene appropriately may place a child at risk for further abuse, with potentially permanent consequences for the child. 2-4 Physical abuse may not be considered in the physician' s differential diagnosis of childhood injury because the caregiver may have intentionally altered the history to conceal the abuse. 5 As a result, when fractures are initially evaluated, a diagnosis of child abuse may be missed. 3 In children younger than 3 years, as many as 20% of fractures caused by abuse may be misdiagnosed initially as noninflicted or as attributable to other causes. 3 In addition, fractures may be missed because radiography is performed before changes are obvious or the radiographic images are misread or misinterpreted. 2 However, incorrectly diagnosing physical abuse in a child with noninflicted fractures has serious consequences for the child and family. To identify child abuse as the cause of fractures, the physician must take into consideration the history, the age of the child, the location and type of fracture, the mechanism that causes the particular type of fracture, and the presence of other injuries while also considering other possible causes. DIFFERENTIAL DIAGNOSIS OF FRACTURES Trauma: Child Abuse Versus Noninflicted InjuriesFractures are a common childhood injury and account for between 8% and 12% of all pediatric injuries. [6][7][8] In infants and toddlers, physical FROM THE AMERICAN ACADEMY OF PEDIATRICSGuidance for the Clinician in Rendering Pediatric Care by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from abuse is the cause of 12% to 20% of fractures. 9 Although unintentional fractures are much more common than fractures caused by child abuse, the physician needs to remain aware of the possibility of inflicted injury. Although some fracture types are highly suggestive of physical abuse, no pattern can exclude child abuse. 10,11 Specifically, it is important to recognize that any fracture, even fractures that are commonly noninflicted injuries, can be caused by child abuse. Certain details that can help the physician determine whether a fracture was caused by abuse rather than unintentional injury include the hist...

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Metaphyseal fractures mimicking abuse during treatment for clubfoot

Cited by 64 publications

References 0 publications

Classic metaphyseal lesion following external cephalic version and cesarean section

Classic metaphyseal lesion following external cephalic version and cesarean section

(iv) Imaging of non-accidental injury

Evaluating Children With Fractures for Child Physical Abuse

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