Prevalence of metaphyseal injury and its mimickers in otherwise healthy children under two years of age

Eide, Pernille; Djuve, Åsmund; Myklebust, Ramona; Forseth, Kjersti Foros; Nøttveit, Andreas; Brudvik, Christina; Rosendahl, Karen

doi:10.1007/s00247-019-04413-5

Cited by 12 publications

(20 citation statements)

References 22 publications

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“…All radiographs were taken on an Intuition DR system (Arcoma AS, Sweden) and, in a later session using a high-resolution PACS screen, reviewed by five of the co-authors and a senior paediatric radiologist (KR). The following features were registered: anatomic region (bone), type (complete (simple/wedge, complex), incomplete (bowing, greenstick/buckle), other (classic metaphyseal lesion (CML), avulsion, fissure), healing signs (periosteal new bone formation / callus (no/yes)), bone structure (osteopenia) no/yes) and metaphyseal appearances (published elsewhere [ 6 ]). For long bone fractures we also registered which segment was involved (proximal, shaft, distal) according to an adjusted version of the Müller classification [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…We have previously shown, in a population-based cohort of 408 children under 2 years of age, that 149 (77 boys) children had a total of 162 fractures, yielding a fracture incidence of 5.9 per 1000 and an incidence of children with fractures of 5.4 per 1000 [ 6 ]. Fractures to the forearm were the most common, accounting for one third of the fractures, followed by tibia and clavicle.…”

Section: Introductionmentioning

confidence: 99%

“…One epiphyseal separation in the left first metatarsal, and one metaphyseal lesion in the proximal left humerus without a history of trauma were also identified. We here report details on injury and fracture incidence, pattern and mechanisms from the same cohort [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence, pattern and mechanisms of injuries and fractures in children under two years of age

Rosendahl

Myklebust²,

Ulriksen³

et al. 2021

BMC Musculoskelet Disord

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Background Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children. Methods This retrospective, cross-sectional study includes all children aged 0–2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist. Results In total 408 children (212 male), 3–23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12–24 months of age. More than half of the fractures (53.1%) were seen in children aged 18–23 months, while none was found in those under 7 months of age. The youngest age group had mostly femur and tibia fractures, the oldest mostly forearm fractures (n = 55, 33.9%), followed by tibia fractures (21.6%) and fractures to the clavicle (14.8%). The reported mechanisms for the 162 fractures were fall from a chair/bed/table (41.4%), fall from own height (18.5%) or crush injury (15.4%). In 8 of 162 (4.9%) fractures, the history was clearly inconsistent and suspicious of non-accidental injury (NAI). Conclusion Injuries and fractures in young children in general, and non-ambulant children in particular, are rare and should be thoroughly assessed for NAI. Level of evidence: Retrospective, population based cross-sectional study. Level 3.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence, pattern and mechanisms of injuries and fractures in children under two years of age

Rosendahl

Myklebust²,

Ulriksen³

et al. 2021

BMC Musculoskelet Disord

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“…Perez‐Rossello et al (2015) concluded that no radiographic or pathological features of rickets were observed in these cases; therefore, the view that CMLs are associated with infantile rickets is not supported. Subsequent case reports in which CMLs were caused during therapeutic treatment (Burrell, Opfer, Berglund, Lowe, & Anderst, 2015; Della Grotta, Marine, Harris, & Karmazyn, 2019), a retrospective study of infants younger than 12 months old seen by an abuse physician (Thackeray, Wannemacher, Adler, & Lindberg, 2016), and a retrospective radiographic study of all children younger than 2 years old seen in an Accident and Emergency Department (Eide et al, 2019) also argue that CMLs are strongly associated with traumatic injuries (Thackeray et al, 2016) and do not occur in otherwise healthy children without a history of trauma (Eide et al, 2019).…”

Section: Pediatric Skeletal Trauma Interpretation and The Contributiomentioning

confidence: 99%

The role of the forensic anthropologist in the pediatric autopsy: Interpretations, contributions, and challenges

Fleischman

Martinez

Wiersema

et al. 2020

WIREs Forensic Science

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Child maltreatment is a growing medicolegal and social concern and forensic anthropologists in the United States are more frequently being asked to participate in pediatric autopsies to evaluate skeletal injuries. These injuries may be occult to medical imaging and the autopsy itself, but the forensic anthropologist directly evaluates the skeletal tissue which can dramatically improve the sensitivity and specificity of the analysis. The training and methods of forensic anthropologists provide them with the unique perspective of comprehending the anatomical, biomechanical, and physiological properties of human pediatric bone which informs their interpretations of time since injury and mechanism of trauma. This perspective also permits the ability to differentiate between growth and development, skeletal anomalies/variants, and traumatized bone which can be of distinct consequence to the forensic pathologist's cause and manner of death determination. This review is intended for forensic anthropologists and others in the medicolegal community who are tasked with identifying and interpreting pediatric skeletal trauma. The research and scholarly work cited herein is the most current bibliography for comprehending the role and contribution(s) of the forensic anthropologist in the pediatric autopsy, the techniques and methods available to them, and the challenges and cautions associated with this delicate work.

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“…The authors have misinterpreted this radiograph which in fact is normal: cupping of the distal ulna is a well-known normal finding in this age group (9,10). For a more detailed discussion on ulnar cupping and other normal variants, readers are directed to articles by Quigley and Stafrace (11) and Eide et al (12).…”

Section: Takedownmentioning

confidence: 99%

European Society of Paediatric Radiology (ESPR) Child Abuse Taskforce Committee: a response to Miller et al.

Paddock

Adamsbaum

Barber

et al. 2020

Journal of Pediatric Endocrinology and Metabolism

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Prevalence of metaphyseal injury and its mimickers in otherwise healthy children under two years of age

Cited by 12 publications

References 22 publications

Incidence, pattern and mechanisms of injuries and fractures in children under two years of age

Incidence, pattern and mechanisms of injuries and fractures in children under two years of age

The role of the forensic anthropologist in the pediatric autopsy: Interpretations, contributions, and challenges

European Society of Paediatric Radiology (ESPR) Child Abuse Taskforce Committee: a response to Miller et al.

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