UMEM Educational Pearls

Title: Subtle radiographic signs of child abuse

Keywords: fractures, child abuse, radiology (PubMed Search)

Posted: 12/10/2011 by Brian Corwell, MD (Updated: 4/24/2024)
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Metaphyseal bucket handle and corner fractures are almost pathognomonic for child abuse

These injuries were originally identified by clinicians evaluating children with subdural hematomas

These injuries are typically seen in the ankles, knees, elbows and wrists

Violent twisting, shaking, or pulling across a joint creates shearing forces across the weak epiphyseal growth plate and metaphysis

This leads to

1) A thin rim of mineralized metaphyseal bone aka “bucket handle”

http://rad.usuhs.mil/rad/home/peds/bucketarrow.jpg

2) Small flecks of bone from the metaphyseal corner adherent to periosteum

http://t2.gstatic.com/images?q=tbn:ANd9GcT0kZ3VR1f7MwRj7oIa6jaYVp_-f8kZ1NhSbw4kCTRGNLDJ1pKK9g