Subperiosteal new bone formation with the distal tibial classic metaphyseal lesion: prevalence on radiographic skeletal surveys

Background The classic metaphyseal lesion (CML) is a strong indicator of infant abuse, and the distal tibia is one of the most common sites for this injury. Objective To determine the prevalence of subperiosteal new bone formation accompanying the distal tibial CMLs identified on infant skeletal sur...

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Bibliographic Details
Published in:Pediatric radiology 2019-04, Vol.49 (4), p.551-558
Main Authors: Tsai, Andy, Connolly, Susan A., Ecklund, Kirsten, Johnston, Patrick R., Kleinman, Paul K.
Format: Article
Language:English
Subjects:
Ankle
Archiving
Babies
Bone growth
Child abuse & neglect
Child Abuse - diagnosis
Child, Preschool
Communications systems
Female
Fractures
Humans
Identification methods
Imaging
Infant
Infants
Injuries
Lesions
Male
Medicine
Medicine & Public Health
Neuroradiology
Nuclear Medicine
Oncology
Original Article
Osteogenesis
Osteogenesis - physiology
Pediatrics
Polls & surveys
Prevalence
Radiographs
Radiography
Radiology
Statistical analysis
Tibia
Tibia - diagnostic imaging
Tibia - injuries
Tibial Fractures - diagnostic imaging
Ultrasound
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Summary:Background The classic metaphyseal lesion (CML) is a strong indicator of infant abuse, and the distal tibia is one of the most common sites for this injury. Objective To determine the prevalence of subperiosteal new bone formation accompanying the distal tibial CMLs identified on infant skeletal surveys. Materials and methods Skeletal surveys performed for suspected infant abuse (2005–2017) were reviewed. Inclusion criteria were 1) anteroposterior (AP) and lateral radiographs of a distal tibial CML from the initial survey, 2) AP radiograph from the 2-week follow-up survey, 3) additional fractures, 4) child protection team consults and 5) mandated report filing for suspected abuse. We identified 22 distal tibial CMLs from 16 infants. Radiographs of these lesions were shown on the picture archiving and communication system to two blinded pediatric radiologists. Readers indicated the presence/absence of subperiosteal new bone formation on individual and combinations of images. Results Inter-reader agreements were fair (kappa=0.47). The prevalence of subperiosteal new bone formation on initial AP radiograph was 34%. Significant increases in the prevalence were found with the addition of follow-up AP radiograph (57%; P
ISSN:0301-0449
1432-1998
DOI:10.1007/s00247-018-4329-z