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The Risk of Assuming Abuse in an Infant with an Isolated Metaphyseal Lesion: A Case Report
Kirsten Norrell1, William Hennrikus
1Departments of Orthopaedic Surgery (K.N. and W.H.) and General Surgery (K.N.), Pennsylvania State University Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Insights
A metaphyseal lesion in infants, often linked to child abuse, can be a normal variant. This case highlights the importance of considering differential diagnoses beyond nonaccidental trauma for such findings.
Area of Science:
- Pediatric Radiology
- Child Abuse Diagnosis
- Skeletal Imaging
Background:
- Metaphyseal lesions, or corner fractures, are traditionally viewed as significant indicators of nonaccidental trauma in infants.
- Accurate diagnosis is crucial, as misinterpretation can lead to false accusations of child abuse.
Case:
The classic metaphyseal lesion, or corner fracture, is considered a strong indicator of nonaccidental trauma. In the present case, the parents brought their 8-month-old boy to a community hospital after he stopped crawling on the right leg. A knee radiograph demonstrated an isolated metaphyseal lesion, which prompted concern for child abuse. The patient was transferred to the nearest academic medical center; the pediatric radiology expert in child abuse determined that the lesion was a normal variant and not the result of abuse.
Conclusion:
An isolated metaphyseal lesion is not pathognomonic for child abuse, and a thoughtful differential diagnosis should be considered.
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