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Variations in acromial ossification simulating infant abuse in victims of sudden infant death syndrome
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655.
Insights
A common ossification variation in the infant scapula, termed pseudoepiphysis, appears as an adjacent bone opacity. This normal finding can be mistaken for an acromial fracture, highlighting the need for careful radiographic interpretation.
Area of Science:
- Orthopedic anatomy
- Pediatric radiology
- Forensic pathology
Background:
- The acromial process of the scapula is a key anatomical landmark.
- Variations in ossification can occur during skeletal development.
- Distinguishing normal variations from traumatic injuries is crucial in pediatric cases.
Purpose of the Study:
- To describe a specific ossification variation of the acromial process in infants.
- To differentiate this normal variation from potential signs of inflicted injury.
Main Methods:
- Postmortem radiographic analysis of 78 infant scapulae.
- Histological examination of the ossific structures.
- Comparison of radiographic findings with known anatomical variations.
Main Results:
- An ossific opacity adjacent to the acromial process was identified in 13% of infants.
- The finding, termed pseudoepiphysis, lacked growth plate cartilage.
- Variations in size and appearance were noted, with bilateral occurrence in some cases.
Conclusions:
- The acromial pseudoepiphysis is a normal ossification variant in infants.
- Radiographic identification of this variation can prevent misdiagnosis of acromial fractures.
- Awareness of this finding aids in differentiating normal anatomy from signs of abuse.
Abstract:
A variation in ossification of the acromial process of the scapula is described. Postmortem radiographs, obtained in 78 infants who died of sudden infant death syndrome, showed an ossific opacity adjacent to the acromial process in 10 infants (13%). This finding was noted bilaterally in six patients and unilaterally in four patients. No two ossicles were identical. Histologically, no growth plate cartilage was evident between the bony structure and the acromion proper; therefore, this appeared to represent a "pseudoepiphysis." Superficially, this normal variation may appear similar to an acromial fracture resulting from infant abuse. However, a careful analysis of the findings of this normal variation should help prevent any confusion with inflicted injury.