Changes in the long bones due to fetal immobility caused by neuromuscular disease. A radiographic and histological study.

Rodrı́guez, José Ignacio; García‐Alix, Alfredo; Palacios, José; Paniagua, Ricardo

doi:10.2106/00004623-198870070-00014

Cited by 133 publications

(80 citation statements)

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“…When injuries were predominately within the physis, extension into the metaphyseal trabeculae was variable and often microscopic. According to Rodriguez et al [19], even in severe bone fragility disorders related to fetal neuromuscular disease, growth plate fractures among 11 neonates were of the Salter-Harris type I or type II variety, none conforming to planar fractures through the primary spongiosa.…”

Section: Lack Of Replication and Confirmation Studiesmentioning

confidence: 99%

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: 99%

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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“…11 Hypomineralized bone, reported in newborn term infants with neuromuscular disease, has been attributed to decreased movement in utero. 12 Standard care for hospitalized premature infants includes swaddling or 'nesting' and decreased sensory and physical stimulation. 13 Hospitalized premature infants, therefore, have limited physical movement.…”

Section: Introductionmentioning

confidence: 99%

Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants

et al. 2008

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Objective: To determine if physical activity delivered by an infant's mother would be as effective in promoting bone mineral acquisition in preterm very low birth weight (VLBW) infants as the same intervention administered by a trained therapist.Patients and methods: Preterm VLBW infants were randomized to receive daily physical activity administered by the infant's mother (MOM, n ¼ 11) or a trained therapist (OT, n ¼ 11), or control (n ¼ 11). Physical activity consisted of range of motion movements against passive resistance to all extremities for 5 to 10 min daily. All infants were fed mother's milk with fortification to 24 kcal oz À1 . Dual energy x-ray of the forearm bone area (BA, cm 2 ), mineral content (BMC, g), and density (BMD, g/cm 2 ) and measurement of bone formation (bone-specific alkaline phosphatase, BAP) and resorption (urine pyridinium crosslinks of collagen, Pyd) were obtained at study entry and at 2.0 kg of body weight.Result: Forearm BA and BMC gains were greater in MOM and OT infants compared to the control infants despite similar postnatal growth rate and nutrient intake. Serum BAP levels decreased in controls but remained unchanged in MOM and OT infants. Urine Pyd levels were similar at baseline to 2.0 kg for all groups. These findings suggest greater bone growth and mineral acquisition in MOM and OT infants than control infants. Conclusion:This study demonstrates that a physical activity program administered by the infant's own mother is as equally effective as therapist-administered physical activity in promoting greater bone growth and mineral acquisition in preterm VLBW infants.

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“…However, the bone mineral content of the fetus or newborn, assessed on roentgeno graphs or measured with absorptiometry, is subnormal in a number of disease states or treatments: in severe maternal vitamin D de ficiency [8], maternal insulin-dependent dia betes mellitus [9], prolonged treatment with magnesium sulphate during pregnancy [10], fetal immobilization due to congenital neuro muscular disease [11], and intrauterine fetal growth retardation (IUGR) [12], A decreased mineral content in the fetal bone is the result of an imbalance between bone formation and bone resorption. Measuring osteocalcin con centrations may help to differentiate between these two possibilities.…”

Section: Introductionmentioning

confidence: 99%

Umbilical Cord Osteocalcin in Normal Pregnancies and Pregnancies Complicated by Fetal Growth Retardation or Diabetes mellitus

Verhaeghe

Herck

Bouillon³

1995

Neonatology

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A homologous radioimmunoassay for human osteocalcin was used to measure cord serum osteocalcm concentrations in normal pregnancies and in pregnancies complicated by intrauterine growth retardation (IUGR) and diabetes. The mean osteocalcin concentrations in term newborns (100–110 μg/l) were comparable with levels that we previously measured in pubertal children. There was a small increase in mean osteocalcin concentrations during the third trimester of fetal life, with the maximum at 35 weeks; between weeks 36 and 41, the osteocalcin levels dropped by 13%. Osteocalcin was 20% lower in IUGR neonates than in age- or weight-matched newborns. The newborns of diabetic mothers had markedly lower osteocalcin concentrations than the weight-matched neonates, and 16 of the 19 samples were more than 1 SD below the mean of the gestational-age osteocalcin regression curve. Cord serum osteocalcin appears to be a useful parameter in studying normal and abnormal fetal mineralization.

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Changes in the long bones due to fetal immobility caused by neuromuscular disease. A radiographic and histological study.

Cited by 133 publications

References 0 publications

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

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

Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants

Umbilical Cord Osteocalcin in Normal Pregnancies and Pregnancies Complicated by Fetal Growth Retardation or Diabetes mellitus

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