Metaphyseal corner fracture

Changed by Jeremy Jones, 3 Nov 2015

Updates to Article Attributes

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Metaphyseal corner fracture, also termed classical metaphyseal lesion (CML), is a fracture observed in young children, less than 2 years old. It is considered pathognomic for non-accidental injury (NAI). 

Prevalence

This injury is not only the fracture most specific for NAI, it is also common among abused children, occurring in ~50% (range 39-59%_%)

Pathophysiology

The biomechanics of metaphyseal fracture is the cumulation of multiple microfractures across the metaphysis with an orientation perpendicular to the long axis of the bone. To-and-fro manipulation (shaking) is the force applied, for example holding the child around the trunk while shaking, with the limbs moving back and forth with a resultant whiplash, or shear force. The microfractures occur in immature mineralised bone.

This injury occurs almost exclusively in children under 2 years of age because:

  • they are small enough to be shaken
  • they cannot protect their limbs

Radiographic features

Conventional radiography

Lucent area within the subphyseal metaphysis perpendicular to the long axis of the bone. The fracture extends across the metaphysis (completely or partially)

Nuclear medicine

Like other fractures there is increased uptake of technetium-99m methylene diphosphonate. However, intense uptake of technetium-99m methylene diphosphonate at the metaphyses is normal in young children; abnormally increased uptake may be difficult to identify. Therefore scintigraphy is considered complementary only (as far as metaphyseal corner fractures are concerned).

See also

  • -<p><strong>Metaphyseal corner fracture</strong>, also termed classical metaphyseal lesion (CML), is a fracture observed in young children, less than 2 years old. It is considered pathognomic for <a href="/articles/non-accidental-injury">non-accidental injury</a> (NAI). </p><h4>Prevalence</h4><p>This injury is not only the fracture most specific for <a href="/articles/nai">NAI,</a> it is also common among abused children, occurring in ~50% (range 39-59%_. </p><h4>Pathophysiology</h4><p>The biomechanics of metaphyseal fracture is the cumulation of multiple microfractures across the metaphysis with an orientation perpendicular to the long axis of the bone. To-and-fro manipulation (shaking) is the force applied, for example holding the child around the trunk while shaking, with the limbs moving back and forth with a resultant whiplash, or shear force. The microfractures occur in immature mineralised bone.</p><p>This injury occurs almost exclusively in children under 2 years of age because:</p><ul>
  • +<p><strong>Metaphyseal corner fracture</strong>, also termed classical metaphyseal lesion (CML), is a fracture observed in young children, less than 2 years old. It is considered pathognomic for <a href="/articles/non-accidental-injury">non-accidental injury</a> (NAI). </p><h4>Prevalence</h4><p>This injury is not only the fracture most specific for <a href="/articles/nai">NAI,</a> it is also common among abused children, occurring in ~50% (range 39-59%). </p><h4>Pathophysiology</h4><p>The biomechanics of metaphyseal fracture is the cumulation of multiple microfractures across the metaphysis with an orientation perpendicular to the long axis of the bone. To-and-fro manipulation (shaking) is the force applied, for example holding the child around the trunk while shaking, with the limbs moving back and forth with a resultant whiplash, or shear force. The microfractures occur in immature mineralised bone.</p><p>This injury occurs almost exclusively in children under 2 years of age because:</p><ul>
  • -</ul><h4>Radiographic features</h4><h5>Conventional radiography</h5><p>Lucent area within the subphyseal metaphysis perpendicular to the long axis of the bone. The fracture extends across the metaphysis (completely or partially)</p><h5>Nuclear medicine</h5><p>Like other fractures there is increased uptake of technetium-99m methylene diphosphonate. However, intense uptake of technetium-99m methylene diphosphonate at the metaphyses is normal in young children; abnormally increased uptake may be difficult to identify. Therefore scintigraphy is considered complementary only (as far as metaphyseal corner fractures are concerned).</p><h4>See also</h4><ul><li><a href="/articles/non-accidental-injuries">non-accidental injury</a></li></ul>
  • +</ul><h4>Radiographic features</h4><h5>Conventional radiography</h5><p>Lucent area within the subphyseal metaphysis perpendicular to the long axis of the bone. The fracture extends across the metaphysis (completely or partially)</p><h5>Nuclear medicine</h5><p>Like other fractures there is increased uptake of technetium-99m methylene diphosphonate. However, intense uptake of technetium-99m methylene diphosphonate at the metaphyses is normal in young children; abnormally increased uptake may be difficult to identify. Therefore scintigraphy is considered complementary only (as far as metaphyseal corner fractures are concerned).</p><h4>See also</h4><ul>
  • +<li><a href="/articles/non-accidental-injuries">non-accidental injury</a></li>
  • +<li><a title="metaphyseal fracture" href="/articles/metaphyseal-fracture-2">metaphyseal fracture</a></li>
  • +</ul>

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