Pernille Eide1, Åsmund Djuve1, Ramona Myklebust2, Kjersti Foros Forseth3, Andreas Nøttveit4, Christina Brudvik4,5, Karen Rosendahl6,7. 1. Faculty of Medicine, University of Bergen, Bergen, Norway. 2. Norheimsund Medical Center, Norheimsund, Norway. 3. Orkerød Nursing Home, Moss, Norway. 4. Bergen Accident and Emergency Department, Bergen, Norway. 5. Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway. 6. Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway. Karen.rosendahl@helse-bergen.no. 7. Section of Paediatric Radiology, Haukeland University Hospital, N-5021, Bergen, Norway. Karen.rosendahl@helse-bergen.no.
Abstract
BACKGROUND: Metaphyseal lesions in infants and toddlers are believed to have a high specificity for inflicted injury. OBJECTIVES: To examine the prevalence of metaphyseal injury and its mimickers in otherwise healthy children younger than 2 years of age. MATERIALS AND METHODS: During 2010-2015, all children 2 years old and younger seen at the Accident and Emergency (A&E) Department due to an injury who had radiographs taken were included. Information on mechanism and clinical findings were drawn from the medical notes. All radiographs were reviewed by two of five researchers together with an experienced paediatric radiologist, registering fracture site and type, and metaphyseal appearances. RESULTS: Four hundred and eight children (212 boys) (mean age: 17.7 months, range: 3-24 months) were included, of whom 149 (77 boys) had a total of 162 fractures (incidence of 5.4 per 1,000 children). Only one metaphyseal lesion, without a history of trauma, was seen. Of the 860 metaphyses analysed, 140 (16.3%) were defined as either irregular (74/860, 8.6%) or as having a metaphyseal collar (66/860, 7.7%). Sixty-four of the 66 collars (97.0%) and 54/104 irregularities (60.8%) were located around the wrist and the ankle, while 25/74 irregularities (33.8%) were found around the knee joint. CONCLUSION: Metaphyseal lesions with a history of trauma did not occur in otherwise healthy neonates and infants younger than 2 years of age, indicating that this type of fracture has a particular trauma mechanism. Metaphyseal irregularities/collars are frequently seen and should not be mistaken for a classic metaphyseal lesion.
BACKGROUND: Metaphyseal lesions in infants and toddlers are believed to have a high specificity for inflicted injury. OBJECTIVES: To examine the prevalence of metaphyseal injury and its mimickers in otherwise healthy children younger than 2 years of age. MATERIALS AND METHODS: During 2010-2015, all children 2 years old and younger seen at the Accident and Emergency (A&E) Department due to an injury who had radiographs taken were included. Information on mechanism and clinical findings were drawn from the medical notes. All radiographs were reviewed by two of five researchers together with an experienced paediatric radiologist, registering fracture site and type, and metaphyseal appearances. RESULTS: Four hundred and eight children (212 boys) (mean age: 17.7 months, range: 3-24 months) were included, of whom 149 (77 boys) had a total of 162 fractures (incidence of 5.4 per 1,000 children). Only one metaphyseal lesion, without a history of trauma, was seen. Of the 860 metaphyses analysed, 140 (16.3%) were defined as either irregular (74/860, 8.6%) or as having a metaphyseal collar (66/860, 7.7%). Sixty-four of the 66 collars (97.0%) and 54/104 irregularities (60.8%) were located around the wrist and the ankle, while 25/74 irregularities (33.8%) were found around the knee joint. CONCLUSION: Metaphyseal lesions with a history of trauma did not occur in otherwise healthy neonates and infants younger than 2 years of age, indicating that this type of fracture has a particular trauma mechanism. Metaphyseal irregularities/collars are frequently seen and should not be mistaken for a classic metaphyseal lesion.
Authors: Nicholas M P Clarke; Fenella R M Shelton; Colm C Taylor; Tajjali Khan; Senbaga Needhirajan Journal: Injury Date: 2011-09-19 Impact factor: 2.586
Authors: Paul K Kleinman; Jeannette M Perez-Rossello; Alice W Newton; Henry A Feldman; Patricia L Kleinman Journal: AJR Am J Roentgenol Date: 2011-10 Impact factor: 3.959
Authors: Emalee G Flaherty; Jeannette M Perez-Rossello; Michael A Levine; William L Hennrikus Journal: Pediatrics Date: 2014-01-27 Impact factor: 7.124
Authors: Sabah Servaes; Stephen D Brown; Arabinda K Choudhary; Cindy W Christian; Stephen L Done; Laura L Hayes; Michael A Levine; Joëlle A Moreno; Vincent J Palusci; Richard M Shore; Thomas L Slovis Journal: Pediatr Radiol Date: 2016-02-17