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Age of children with metaphyseal fractures

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


These studies all relate to live children 1-6

  • A study of 215 children aged less than three years old described 13 abusive humeral fractures, including metaphyseal fractures 4
  • A study of 34 infants aged less than one year old: 5
    • 19 long bone fractures and five metaphyseal fractures were recorded
    • No differentiation between abusive and non-abusive by fracture type is given in this study
  • A study of 60 infants aged less than one year of age, 42 of whom were deemed ‘low risk’ of abuse and 18 ‘high risk’ (abuse rank two) determined that 9 / 18 children in the high risk but no child with a ‘low risk’ had classic metaphyseal lesions (CML) 3
    • The CML involved all long bones but, more frequently, femur and tibia.  55% of CML were found around the knee
  • A study of 63 femoral fracture episodes in children aged less than four years old (pathological fractures and MVC excluded): 2
    • 24 fractures were due to abuse / suspected abuse
      • Four were distal metaphyseal chip fractures
      • A further five were distal metaphyseal fractures
    • Of the 39 non-abusive fractures, five were distal metaphyseal fractures, one of which was a chip fracture
  • A study of 826 children with accidental fractures and 35 children under five years old with abusive fractures 6
    • 17 metaphyseal corner fractures were noted among the abused children, all aged less than 18 months old
    • There were no metaphyseal fractures in the accident group
  • A study of infants aged less than one year showed the mean age of those with metaphyseal fractures was 4 months 1
    • 15 out of 50 had bilateral symmetrical lower extremity metaphyseal fractures. 42 out of 48 children with CML had positive skeletal survey for occult fractures
    • One nine day old infant had CML as a consequence of birth

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  1. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatric Radiology. 2015;45(1):69-80 [Pubmed]

  2. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse. Journal of Pediatric Orthopaedics. 1983;3(5):583-586 [Pubmed]
  3. Kleinman PK, Perez-Rossello JM, Newton AW, Feldman HA, Kleinman PL. Prevalence of the classic metaphyseal lesion in infants at low versus high risk for abuse. American Journal of Roentgenology. 2011;197(4):1005-1008 [Pubmed]
  4. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  5. McClelland CQ, Heiple KG. Fractures in the first year of life. A diagnostic dilemma. American Journal of Diseases of Children. 1982;136(1):26-29 [Pubmed]
  6. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]


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