A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus

AJR. American Journal of Roentgenology
P K Kleinman, S C Marks

Abstract

The purpose of this study was to systematically analyze the spectrum of morphologic alterations of the classic metaphyseal lesion (CML) involving the proximal humerus of abused infants and to identify radiologic features that aid in the diagnosis and assessment of healing. Thirty-one infants who died with evidence of inflicted skeletal injury were studied with high-detail skeletal surveys, resected specimen radiography, and histologic analysis. In each infant, the number of fractures, the involved portions of the proximal humeral metaphyses, and the age of the lesion were assessed. Seven proximal humeral CMLs were seen in four infants. Radiography of the only infant with an acute injury revealed no fracture; however, evidence of trabecular disruption was found histologically. Radiographic patterns in the six healing injuries included focal corner-fracture appearance, transmetaphyseal radiolucency, irregularity of the metaphyseal margin, and flame-shaped mineralized extensions into the physeal cartilage. Histologically, all CMLs undercut the lateral subperiosteal bone collar, explaining the corner-fracture appearance. Focal and diffuse thickening of the zone of hypertrophic chondrocytes was seen, and peninsulas of primary spongi...Continue Reading

Citations

Oct 4, 2008·BMJ : British Medical Journal·Alison M KempSabine Maguire
Mar 24, 2010·Radiology·Laura A DrubachPaul K Kleinman
Jul 11, 2003·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Gael J LonerganSteven C Boos
Dec 29, 2013·AJR. American Journal of Roentgenology·David M AyoubMarvin Miller
Feb 18, 2015·Radiology·Jeannette M Perez-RosselloPaul K Kleinman
Mar 17, 2004·Current Opinion in Pediatrics·Rebecca Tenney-Soeiro, Celeste Wilson
Dec 2, 2014·Clinics in Orthopedic Surgery·Sumanth Kumar GeraArjandas Mahadev
Oct 28, 2018·Pediatric Radiology·Boaz KarmazynRoberta A Hibbard
Jan 24, 2020·Pediatric Radiology·Boaz KarmazynRoberta A Hibbard
Feb 5, 2010·The Journal of Bone and Joint Surgery. British Volume·P JayakumarM Ramachandran

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