The metaphyseal lesion in abused infants: a radiologic-histopathologic study

Abstract

MA 01605. Address reprint requests to P. K. Kleinman. 2p , t of Anatomy, lk'iiversity of Massachusetts Medical Center, Worcester, MA 01605. Depending upon the size of the injury, the degree of involvement of the periphery of the bone, and the radiographic projection, a bucket-bundle lesion, corner fracture, or metaphyseal lucency will result In some cases, the radiographs may be normal even though there is significant histologic alteration. Although cartilaginous injuries may play a role in infant abuse, none of the specimens examined in this study evidenced injury through the germinal layers of cartilage.On the basis of the findings described here, it is recoinmended that postmortem analysis of all radiographically suspicious metaphyses be carried out in cases of suspected infant hOmiCide. If there are other clinical or pathologic indications to support abuse, a strong argument can be made for removal of radiologically normal but high-risk metaphyses.Instituting these procedures will require closer cooperation between the radiologist and the medical examiner, but the potential to Caffey, "After the application of injuring force to the bone, it is transmitted to these terminal levels of tightest attachment;where the injuring force is sufficiently strong, bits of cartilage and bone are torn off and displayed in a variety of patterns" [2]. Caffey also asserted that when a "small chunk" of bone is pulled from the margin of the metaphysis, it projects as a discrete metaphyseal fragment. This pattern is frequently

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

“…We found only nine studies in the peer-reviewed literature that had correlated histopathology with radiologically defined classic metaphyseal lesions in infants [1,3,[7][8][9][10][11][12][13]. Studies that met our primary search criteria were published between 1986 and 1998 by the same principal investigator, pediatric radiologist Paul Kleinman at the University of Massachusetts, Worcester, in collaboration with the office of the chief medical examiner for the Commonwealth of Massachusetts and later at Boston Children's Medical Center.…”

Differentiation of child abuse from osteogenesis imperfecta.

“…The features in clinical history and physical examination that are helpful to the radiologist in diagnosing child abuse [63][64][65] are listed in Table 4, and the salient radiologic features of child abuse [33, [64][65][66][67][68] are summarized in Table 5. The keys to distinguishing 01 from abuse are the presence of blue sclena on abnormal teeth; investigation of clinical and family [64][65][66]. They both result from the same pathologic injury and are simply vaniations in appearance due to different radiographic projections [64,66].…”

“…The keys to distinguishing 01 from abuse are the presence of blue sclena on abnormal teeth; investigation of clinical and family [64][65][66]. They both result from the same pathologic injury and are simply vaniations in appearance due to different radiographic projections [64,66]. These types of fractures occur in relatively young infants, usually less than 1 year old, and are highly specific for abuse.…”

“…1 1 , see also (see Figs. 1 1 B and 1 1C), are highly specific of child abuse [64][65][66]. Transverse, oblique, or spinal fracture of a long bone with normal mineralization (see Fig.…”

“…Transverse, oblique, or spinal fracture of a long bone with normal mineralization (see Fig. 9C) in the absence of significant accidental trauma on fracture inconsistent with given history, especially in a nonambulatory infant, are also highly suggestive of child abuse [64][65][66][67].…”