Metaphyseal corner fracture (child abuse)

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This toddler was brought to the ED with irritability.

Patient Data

Age: 1-2 years
Gender: Male

Radiographs of left lower leg

x_ray

There is a subtle fracture at the anterior aspect of the distal left tibia.

Annotated image

Magnified key image of the fracture. 

Case Discussion

Appearances are consistent with a metaphyseal corner fracture.

In this age group, a metaphyseal injury is not in keeping with accidental trauma. A metaphyseal corner fracture is highly specific for non-accidental injury in a non-ambulant infant. A notable exception is obstetric trauma during difficult delivery.

In this case, there were no other radiological features of NAI.

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