We have located links that may give you full text access.
Comparative Study
Journal Article
A regional approach to classic metaphyseal lesions in abused infants: the distal tibia.
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.
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.
Full text links
Related Resources
Trending Papers
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities.Diabetologia 2024 April 17
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Eosinophilic Esophagitis: Clinical Pearls for Primary Care Providers and Gastroenterologists.Mayo Clinic Proceedings 2024 April
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app