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The classic metaphyseal lesion and traumatic injury

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Abstract

Background

It is widely accepted that the classic metaphyseal lesion (CML) is a traumatic lesion, strongly associated with abuse in infants. Nevertheless, various non-traumatic origins for CMLs continue to be suggested in medical and legal settings. No studies to date systematically describe the association of CMLs with other traumatic injuries.

Objective

The primary objective of this study is to examine the association of CMLs with other traumatic injuries in a large data set of children evaluated for physical abuse.

Materials and methods

This was a retrospectively planned secondary analysis of data from a prospective, observational study of children <120 months of age who underwent evaluation by a child abuse physician. For this secondary analysis, we identified all children ≤12 months of age with an identified CML and determined the number and type of additional injuries identified. Descriptive analysis was used to report frequency of additional traumatic injuries.

Results

Among 2,890 subjects, 119 (4.1%) were identified as having a CML. Of these, 100 (84.0%) had at least one additional (non-CML) fracture. Thirty-three (27.7%) had traumatic brain injury. Nearly half (43.7%) of children had cutaneous injuries. Oropharyngeal injuries were found in 12 (10.1%) children. Abdominal/thoracic injuries were also found in 12 (10.1%) children. In all, 95.8% of children with a CML had at least one additional injury; one in four children had three or more categories of injury.

Conclusion

CMLs identified in young children are strongly associated with traumatic injuries. Identification of a CML in a young child should prompt a thorough evaluation for physical abuse.

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Acknowledgments

We thank Kristine Campbell for her important contributions to early versions of the project protocol. The Examining Siblings To Recognize Abuse (ExSTRA) investigators are: Jayme Coffman, MD (Cook Children’s Hospital, Ft. Worth, TX); Deb Bretl, APNP (Children’s Hospital Wisconsin, Wauwatosa, WI); Nancy Harper, MD (Driscoll Children’s Hospital, Corpus Christi, TX); Katherine Deye, MD (Children’s National Medical Center, Washington, DC); Antoinette Laskey, MD, MPH, and Tara Harris, MD (Riley Hospital for Children, Indianapolis, IN); Yolanda Duralde, MD (Mary Bridge Children’s Health Center, Tacoma, WA); Marcella Donaruma-Kwoh, MD (Texas Children’s Hospital, Houston, TX); Daryl Steiner, DO (Akron Children’s Hospital, Akron, OH); Ken Feldman, MD (Seattle Children’s Hospital, Seattle, WA); Kimberly Schwartz, MD (University of Massachusetts Medical Center, Worcester, MA); Robert Shapiro, MD, and Mary Greiner, MD (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH); Alice Newton, MD (Boston Children’s Hospital, Boston, MA); Rachel Berger, MD, MPH, and Ivone Kim, MD (Children’s Hospital Pittsburgh or University of Pittsburgh Medical Center); Kent Hymel, MD (Dartmouth-Hitchcock Medical Center, Lebanon, NH); Suzanne Haney, MD (Children’s Hospital & Medical Center, Omaha, NE); Alicia Pekarsky, MD (SUNY Upstate Medical University, Syracuse, NY); Andrea Asnes, MD (Yale-New Haven Children’s Hospital, New Haven, CT); Paul McPherson, MD (Akron Children’s Hospital, Youngstown, OH); Neha Mehta, MD (Sunrise Children’s Hospital, Las Vegas, NV), and Gwendolyn Gladstone, MD (Exeter Pediatric Associates, Exeter, NH).

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Authors and Affiliations

  1. Division of Child and Family Advocacy, Nationwide Children’s Hospital, 655 E. Livingston Ave., Columbus, OH, 43205, USA

    Jonathan D. Thackeray

  2. The Ohio State University College of Medicine, Columbus, OH, USA

    Jacob Wannemacher

  3. Department of Radiology, Nationwide Children’s Hospital, Columbus, OH, USA

    Brent H. Adler

  4. Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Denver, CO, USA

    Daniel M. Lindberg

Authors
  1. Jonathan D. Thackeray
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  2. Jacob Wannemacher
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  3. Brent H. Adler
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  4. Daniel M. Lindberg
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Corresponding author

Correspondence to Jonathan D. Thackeray.

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Conflicts of interest

Drs. Lindberg and Thackeray have given paid expert witness testimony in cases with concern for physical abuse.

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Thackeray, J.D., Wannemacher, J., Adler, B.H. et al. The classic metaphyseal lesion and traumatic injury. Pediatr Radiol 46, 1128–1133 (2016). https://doi.org/10.1007/s00247-016-3568-0

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  • DOI: https://doi.org/10.1007/s00247-016-3568-0

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