- Metaphyseal fractures may be missed if appropriate radiology is not employed 1,2
- Inappropriately administered physiotherapy, particularly to preterm infants, has caused metaphyseal fractures 3
- Metaphyseal fractures are also recorded in serial casting of clubfoot 4
- Birth trauma can cause metaphyseal fractures in breech delivery 5
- External cephalic version for breech presentation may result in classic metaphyseal lesion (CML) 6
- CML occuring following birth was associated with pain expressed in irritability, lack of spontaneous movement of the affected leg and poor feeding in an infant 6
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References
- Royal College of Radiologists. Standards for Radiological Investigations of Suspected Non-accidental Injury. Joint document produced in collaboration with the Royal College of Paediatrics and Child Health. London: RCR [Most recent version available to download from RCR website]
- American College of Radiology. Practice Guideline for Skeletal Surveys in Children (PDF). [Most recent version available to download from ACR website]
- Helfer RE, Scheurer SL, Alexander R, Reed J,Slovis TL. Trauma to the bones of small infants from passive exercise: a factor in the etiology of child abuse. Journal of Pediatrics. 1984;104(1):47-50 [Pubmed]
- Grayev AM, Boal DKB, Wallach DM, Segal LS. Metaphyseal fractures mimicking abuse during treatment for clubfoot. Pediatric Radiology. 2001;31(8):559-563 [Pubmed]
- Altman DH, Smith RL. Unrecognised trauma in infants and children. Journal of Bone and Joint Surgery. 1960;42(3):407-413 [Pubmed citation only]
- Lysack JT, Soboleski D. Classic metaphyseal lesion following external cephalic version and cesarean section. Pediatric radiology. 2003;33(6):422-424 [Pubmed]