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A regional approach to classic metaphyseal lesions in abused infants: the distal tibia
1Department of Radiology, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
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Classic metaphyseal lesions (CML) in abused infants
Area of Science:
- Pediatric radiology
- Forensic pathology
- Skeletal imaging
Background:
- Classic metaphyseal lesions (CML) are critical indicators of non-accidental trauma in infants.
- Understanding the radiographic and histopathologic features of CML is essential for accurate diagnosis.
- The distal tibia is a common site for CML, requiring detailed analysis.
Purpose of the Study:
- To systematically analyze the morphologic spectrum of CML in the distal tibia of abused infants.
- To identify radiologic features aiding in the diagnosis and assessment of healing CML.
- To correlate radiologic findings with histopathologic characteristics.
Main Methods:
- Study included 31 infants with evidence of inflicted injury.
- High-detail skeletal surveys, resected-specimen radiography, and histopathologic analysis were performed.
- Assessment focused on fracture number, metaphyseal location, and lesion age.
Main Results:
- 16 CML of the distal tibia were identified.
- Medial metaphyseal involvement was consistently observed; lateral involvement indicated more extensive injury.
- Fractures were more conspicuous during healing, often presenting as tall, triangular medial fragments.
Conclusions:
- CML of the distal tibia exhibit distinct radiologic and histopathologic features related to regional anatomy.
- Radiograph quality significantly impacts visualization of these fractures.
- Knowledge of CML characteristics aids in recognizing this key indicator of infant abuse.
Objective:
The purpose of this study was to analyze systematically the spectrum of morphologic alterations of classic metaphyseal lesions (CML) involving the distal tibia of abused infants and to identify features that assist in the radiologic diagnosis and assessment of healing.
Materials And Methods:
Thirty-one infants who died with evidence of inflicted injury were studied with high-detailed skeletal surveys, resected-specimen radiography, and histopathologic analysis. The number of fractures identified, the portions of the distal tibial metaphyses involved, and the age of the lesion were assessed.
Results:
A total of 16 CML of the distal tibia were noted. Eight infants had unilateral injury that always involved the left side, and four had bilateral lesions. When a CML was visible radiographically, it was always seen along the medial aspect of the metaphysis; lateral metaphyseal involvement was evident with more extensive injuries and always accompanied medial involvement. Fractures tended to be less conspicuous when acute and were more easily recognized with healing, especially with specimen radiography. Radiographically, the typical fracture separated a medial fragment that was tall and triangular; this appearance was histologically related to the undercutting of the long subperiosteal bone collar. In healing lesions, extension of hypertrophic chondrocytes from the growth plate into the region of the fracture was a consistent finding.
Conclusion:
CML of the distal tibia have distinctive radiologic and histopathologic characteristics that relate to the anatomy of the region. Visualization of these fractures depends on the quality of the radiographs obtained. An understanding of the radiologic and histopathologic features of CML should aid in the recognition of this strong indicator of infant abuse.