Heather Borders, MD
over 6 years ago
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Classic Metaphyseal Fracture of Abuse
Joseph Junewick, MD FACR
|Diagnostic Category: Trauma
|Created: over 5 years ago
|Updated: over 5 years ago
3 month old with possible inflicted trauma.
Metaphyseal Corner – Bucket Handle Fracture
CR – Triangular metaphyseal fragment anterior to the distal tibia with bucket handle component (arrows).
Caffey initially described the bucket handle fracture, a metaphyseal fracture that is virtually pathognomonic of inflicted injury. These injuries are present nearly half of abused children less than 18 months of age and thought to be related to shear forces at the metaphysis-physis junction from violent shaking of the child. Most bucket handle fractures occur in the distal femur, proximal tibia, distal tibia, and proximal humerus. The periphery of the fracture extends obliquely toward the diaphysis creating a triangular fragment (corner fracture) whereas the central portion of the fracture extends toward the physis resulting in a thin fragment (bucket handle). The bony trabeculae in the primary spongiosa and the columns of calcified cartilage extending into the metaphysis are disrupted but the periosteum is usually intact. With healing there is little or no callus formation since the periosteum is relatively uninjured. Fortunately, the long-term sequelae of these injuries appear to be minimal.
Lonergan GJ, Baker AM, Morey MK, et al. From the Archives of the AFIP Child Abuse: Radiologic-Pathologic Correlation. Radiographics (2003); 23:811-845.