Imaging description

Skeletal injuries that have a high predictive value for non-accidental trauma (NAT) include metaphyseal corner fractures, posterior rib fractures, scapula fractures, and spinous process fractures. These bones are usually difficult to break. Humeral and femoral shaft fractures, particularly distal shaft fractures, are the most common long bone fractures in NAT and should be treated with suspicion in children less than three years [1–3]. Moreover, the presence of multiple fractures of different ages is highly suspicious for NAT.

Metaphyseal corner fractures of NAT, also referred to as “metaphyseal lesions” are avulsion fractures of an arcuate metaphyseal fragment passing through the primary spongiosa overlying the lucent epiphyseal cartilage. This results in irregularity and fragmentation of the metaphysis (Figure 101.1). When a classic metaphyseal lesion is suspected, two radiographic projections of the affected joint are required to avoid confusion with mild physiologic irregularity of the metaphysis or chronic stress such as in malignancy [4]. Metaphyseal fractures of child abuse are most commonly encountered around the knee or elbow. They are also discussed in Case 99.