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Results

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.

 

Overall results for metaphyseal fractures

  • No comparative studies of metaphyseal fractures were suitable for meta-analysis
  • Study designs:
    5 cross-sectional 1,3,10-12
    4 case series 2,4,6-8
    3 case-control 5,9,13
  • Age range: 0 – 15 years 
  • No study addressed disabled children
  • No study addressed the influence of ethnicity and socio-economic group

 

Details of included studies

  • Femoral metaphyseal fractures are far more common among abused than non-abused infants 1,3
  • Eleven studies reported metaphyseal corner fractures 3-13
  • Humeral metaphyseal fractures were reported amongst 11 abused cases but in none of the three accidental cases 12

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References

  1. Anderson WA. The significance of femoral fractures in children. Annals of Emergency Medicine. 1982;11(4):174-177 [Pubmed]
  2. 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]

  3. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse. Journal of Pediatric Orthopaedics. 1983;3(5):583-586 [Pubmed]
  4. Kleinman PK, Marks SC Jr, Richmond JM, Blackbourne BD. Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. American Journal of Roentgenology. 1995;165(3):647-650 [Pubmed]
  5. Kleinman PK, Marks SC Jr. A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. American Journal of Roentgenology. 1996:166(5);1207-1212 [Pubmed]
  6. Kleinman PK, Marks SC Jr. A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus. American Journal of Roentgenology. 1996;167(6):1399-1403 [Pubmed]
  7. Kleinman PK, Marks SC Jr. A regional approach to the classic metaphyseal lesion in abused infants: the proximal tibia. American Journal of Roentgenology. 1996;166(2):421-426 [Pubmed]
  8. Kleinman PK, Marks SC Jr. A regional approach to the classic metaphyseal lesion in abused infants: the distal femur. American Journal of Roentgenology. 1998;170(1):43-47 [Pubmed]
  9. 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]
  10. 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]
  11. 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]
  12. Thomas SA, Rosenfield NS, Leventhal JM, Markovitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics. 1991;88(3):471-476 [Pubmed]
  13. 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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