Dating Metaphyseal Fractures

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Dating fractures in infants - ScienceDirect
Dating fractures | Radiology Key
PDF Annotations The radiological dating of injuries
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Metaphyseal fractures have not been included as they are frequently less symptomatic and it is not possible to accurately identify the date of injury . The level of interobserver agreement for the presence of the radiological features of fracture healing was also assessed . . . . Accurate dating of fractures in infants is an important but difficult . . .
While some scientific studies have been published on fracture dating in general, prior reports have shortcomings that limit the applicability of data to cases of abuse (3, 4, 6, 10, 32 -34) . Inflicted skeletal injuries are more common in younger age groups and most frequent in infants (15 -18) .
radiological dating of fractures and even less relating fractureagetochildabuse . Themostcomprehensivereview is byO'ConnorandCohen .' . . . Fresh fractures , including metaphyseal fractures , have sharply defined margins . With the development of an osteoclastic response to necrotic bone the fracture ends
Radiologic dating of fractures is an inexact science . Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource . There is an urgent need for research to validate the criteria used in the radiologic dating of fractures in children younger than 5 years .
It is known that it is more difficult to date certain fractures over others including metaphyseal fractures and skull fractures . Experienced paediatric radiologists are usually instructed to assist in such cases as they have the skill and up to date knowledge/ experience to date the fractures are easily as possible .
Metaphyseal fractures are fractures that involve the metaphysis of tubular bones . They may occur in paediatric or adult patients . Examples of metaphyseal fractures : adults . surgical neck of humerus fracture ; distal radial fracture ; transtrochanteric fracture ; children . distal radial buckle fracture ; Not all metaphyseal fractures intersect the physis .
These metaphyseal abnormalities were identified from postmortem radiogra-phy and correlated with microscopy . The au-thors concluded the metaphyseal alterations represented partial or complete planar micro- fractures that transected the primary spongio-sa adjacent to the growth plate . These micro- fractures usually resembled a "bucket-handle"
www .courts .ca .gov › documents › Dr ._Marvin_Miller_Unexplained_Fractrues .pdf
metaphyseal fractures (CMLs) following cesarean delivery . All of the CMLs were diagnosed radiographically or by clinical features on day 2 of life . Two of the infants were in the breech presentation, and in the third case the mother had poorly controlled gestational diabetes . While the authors attribute these fractures to twisting and pulling of the
Most of what is known about fracture healing comes from studies of shaft fractures in long bones . In contrast, patients more often have fractures closer to the ends (metaphyses) . Here most bone tissue has a spongy, cancellous structure different from the compact bone of the shaft . There is an increasing awareness that
Specific fractures . A number of fractures have been recognised as highly specific to non-accidental injuries (rather than accidental injury) . They include: metaphyseal fracture (so-called bucket handle fracture or corner fracture ) present in up to 39-50% of abused infants <18 months; said to be virtually pathognomonic of NAI; rib fractures
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Dating Metaphyseal Fractures