Dating metaphyseal fractures

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Metaphyseal fractures are also known as corner fractures, bucket handle fractures or metaphyseal lesions. It refers to an injury to the metaphysis which is the growing plate at each end of a long bone such as tibia, femur, etc. The metaphysis is not actually a bone but is a piece of cartilage it only fully ossifies when we are adults. For years, the mechanism for such injury was thought to be a twist and a pull being applied to the limb rather than any direct force or fall.
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Diagnostic Imaging in child abuse

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[Metaphyseal comminuted fracture. A therapeutic challenge]

The biomechanics of metaphyseal fracture is the cumulation of multiple microfractures across the metaphysis with an orientation perpendicular to the long axis of the bone. To-and-fro manipulation shaking is the force applied, for example holding the child around the trunk while shaking, with the limbs moving back and forth with a resultant whiplash or shear force. The microfractures occur in immature mineralized bone. Although associated with non-accidental injury, in newborns they may be related to traumatic delivery during a breach presentation 4. Radiolucent area within the subphyseal metaphysis perpendicular to the long axis of the bone. The fracture extends across the metaphysis completely or partially.
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Imaging in Child Abuse

The most frequent localization of fractures in elderly patients are the metaphysis of the distal radius, the metaphysis of the proximal humerus and the metaphysis of the proximal femur. Displaced fractures of the distal radius should be reduced anatomically with a broad indication for surgery. A unilateral frame is the method of choice in multi-fragmentary and articular fractures although this procedure carries some disadvantages. Displaced proximal fractures of the head of the humerus should be reduced and fixed operatively.
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Battered child syndrome, shaken infant syndrome, stress-related infant abuse and non accidental trauma are all terms to describe the complex of non-accidental injuries in infants and young children as a result of abuse. The term shaken infant syndrome probably best describes the classic pattern of injuries. The child is held around the chest and violently shaken back and forth. This causes the extremities and the head to flail back and forth in a whiplash movement. Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object.
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