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A regional approach to the classic metaphyseal lesion in abused infants: the proximal tibia
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Insights
Classic metaphyseal lesions (CMLs) in abused infants show distinct features on proximal tibia radiographs. Careful evaluation aids in diagnosing infant abuse and assessing fracture healing.
Area of Science:
- Pediatric Radiology
- Forensic Pathology
- Skeletal Radiology
Background:
- Classic metaphyseal lesions (CMLs) are a hallmark of non-accidental trauma in infants.
- The proximal tibia is a frequent site for CMLs, necessitating detailed radiologic assessment.
Purpose of the Study:
- To systematically analyze the morphologic spectrum of CMLs in the proximal tibia of abused infants.
- To identify radiologic and histopathologic features aiding in diagnosis and healing assessment.
Main Methods:
- High-detail skeletal surveys, specimen radiography, and histopathology were used on 31 infants with inflicted skeletal injuries.
- Assessment included fracture identification, metaphyseal involvement, and lesion age.
Main Results:
- Seventeen proximal tibial CMLs were identified, some bilateral.
- Radiographically visible lesions predominantly involved the medial metaphysis; healing fractures were more conspicuous.
- Histology revealed fracture lines undercutting the medial subperiosteal bone collar with chondrocyte extension.
Conclusions:
- Proximal tibial CMLs possess characteristic radiologic and histopathologic features tied to regional anatomy.
- The proximal tibia is a common site for CMLs, a strong indicator of infant abuse.
- High-detail radiographs of the proximal tibia are crucial in suspected infant abuse cases.
Objective:
The purpose of this study was to systematically analyze the spectrum of morphologic alterations of the classic metaphyseal lesion (CML) involving the proximal tibia of abused infants and to identify features that aid in the radiologic diagnosis and assessment of healing.
Materials And Methods:
Thirty-one infants who died with evidence of inflicted skeletal injury were studied with high-detail skeletal surveys, resected specimen radiography, and histopathologic analysis. The number of fractures identified, the portions of the proximal tibial metaphyses involved, and the age of the lesions were assessed.
Results:
Seventeen proximal tibial CMLs were noted. They were bilateral in six instances and unilateral in five. When the lesion was visible radiographically, it always involved the medial aspect of the metaphysis, with involvement of the lateral metaphyseal margin in more extensive injuries. Fractures tended to be less conspicuous when acute and were more easily recognizable with healing, especially with specimen radiography. Histologically, the fracture line consistently undercut the medial subperiosteal bone collar. Extension of hypertrophic chondrocytes from the growth plate into the region of fracture was a common finding.
Conclusion:
The CML of the proximal tibia has distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. Because the proximal tibia is a common site for this strong indicator of infant abuse, the region should be carefully evaluated with well-collimated, high-detail skeletal radiographs in all cases of suspected infant abuse.