The Risk of Assuming Abuse in an Infant with an Isolated Metaphyseal Lesion

Abstract

An isolated metaphyseal lesion is not pathognomonic for child abuse, and a thoughtful differential diagnosis should be considered.

Correlation Between Fractures and Abuse in Children: A Retrospective Analysis

“…1 One of the first descriptions of orthopedic manifestations directly related to child abuse was performed by Caffey 2 in 1946, describing metaphyseal lesion of long bones in children with multiple injuries, and later coining the term "corner fracture," which is the fracture through immature metaphyseal bone near the growth plate. 3 In 1962, Kempe et al 4 introduced the designation "battered child syndrome," which brought medical attention to the problem of child abuse and led to the creation of compulsory notification laws. Originally, child abuse was defined as a physical injury inflicted on children by their caregivers.…”

“…Since then the definition has expanded to include physical neglect, exposure to danger and emotional and sexual abuse. 2,3 Another important term is non-accidental trauma: action resulting from an act of omission, direct or indirect action that results in harm to the child or impairs his/her health and physical, mental or emotional development. 5 In addition to being a public health problem, exposure to child abuse is associated with negative long-term consequences, including involvement with the criminal system 6 and recurrent use of mental health services.…”

“…8069, health professionals are obliged to notify suspected or confirmed cases of abuse against children and adolescents. 8 Zimmerman et al 9 reported that 50% of 243 abused children were under the age of one and 78% were under the age of three; 80% of the fractures were due to abuse in children under 18 months 3 and abuse was the third cause of death of 1 to 4-year-old children. 5 Younger children have a higher death rate due to maltreatment.…”

“…2 In children under the age of three, 20% of fractures caused by maltreatment are misdiagnosed or attributed to other causes. 3 In addition, fractures may go unnoticed by poorly done or misinterpreted radiographs. 10 The incidence of fractures in children ranges from 8-12% in the literature.…”

“…1 One of the first descriptions of orthopedic manifestations directly related to child abuse was performed by Caffey 2 in 1946, describing metaphyseal lesion of long bones in children with multiple injuries, and later coining the term “corner fracture,” which is the fracture through immature metaphyseal bone near the growth plate. ( 3 …”