Are classic metaphyseal lesions pathognomonic for child abuse? Two cases of motor vehicle collision-related extremity CML and a review of the literature

Long bone fractures at the infant growth plate, known as classic metaphyseal lesions (CMLs), raise a strong suspicion for abusive injury. CMLs persist as a hallmark for inflicted injury although a handful of documented cases of CMLs created by other, non-abusive mechanisms within various healthcare...

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Bibliographic Details
Published in:Journal of forensic and legal medicine 2020-08, Vol.74, p.102006-102006, Article 102006
Main Authors: Culotta, Paige A., Burge, Lauren R., Bachim, Angela N., Donaruma-Kwoh, Marcella
Format: Article
Language:English
Subjects:
Abuse
Accidental injury
Accidents, Traffic
Child Abuse - diagnosis
Classic metaphyseal fractures
Diagnosis, Differential
Female
Femur - diagnostic imaging
Femur - injuries
Growth Plate - diagnostic imaging
Humans
Infant
Motor vehicle collisions
Radiography
Radius Fractures - diagnostic imaging
Radius Fractures - etiology
Salter-Harris Fractures - diagnostic imaging
Salter-Harris Fractures - etiology
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Summary:Long bone fractures at the infant growth plate, known as classic metaphyseal lesions (CMLs), raise a strong suspicion for abusive injury. CMLs persist as a hallmark for inflicted injury although a handful of documented cases of CMLs created by other, non-abusive mechanisms within various healthcare settings are scattered throughout the past few decades of medical literature. The forces required to sustain a CML are typically defined as a combination of tensile, compressive, or rotational energy applied to the metaphyseal regions of an infant's long bones. Recently, two separate child protection teams each encountered a case of CML discovered after reported motor vehicle collisions (MVC). This provoked a critical appraisal of the medical literature to inform clinical practice regarding MVCs as a potential mechanism for this fracture type and to remind clinicians that there is no single injury pathognomonic for abuse. •Classic metaphyseal lesions (CMLs) are highly specific for child physical abuse.•On rare occasions CMLs have been described with iatrogenic causes in the medical literature.•MVCs as a potential mechanism for this fracture type.•A meticulous medical history is needed to ascertain the plausibility of any injury mechanism before concluding child abuse is the cause.
ISSN:1752-928X
1878-7487
DOI:10.1016/j.jflm.2020.102006