The classic metaphyseal lesion and traumatic injury

Pediatr Radiol. 2016 Jul;46(8):1128-33. doi: 10.1007/s00247-016-3568-0. Epub 2016 Feb 22.


Background: It is widely accepted that the classic metaphyseal lesion (CML) is a traumatic lesion, strongly associated with abuse in infants. Nevertheless, various non-traumatic origins for CMLs continue to be suggested in medical and legal settings. No studies to date systematically describe the association of CMLs with other traumatic injuries.

Objective: The primary objective of this study is to examine the association of CMLs with other traumatic injuries in a large data set of children evaluated for physical abuse.

Materials and methods: This was a retrospectively planned secondary analysis of data from a prospective, observational study of children <120 months of age who underwent evaluation by a child abuse physician. For this secondary analysis, we identified all children ≤12 months of age with an identified CML and determined the number and type of additional injuries identified. Descriptive analysis was used to report frequency of additional traumatic injuries.

Results: Among 2,890 subjects, 119 (4.1%) were identified as having a CML. Of these, 100 (84.0%) had at least one additional (non-CML) fracture. Thirty-three (27.7%) had traumatic brain injury. Nearly half (43.7%) of children had cutaneous injuries. Oropharyngeal injuries were found in 12 (10.1%) children. Abdominal/thoracic injuries were also found in 12 (10.1%) children. In all, 95.8% of children with a CML had at least one additional injury; one in four children had three or more categories of injury.

Conclusion: CMLs identified in young children are strongly associated with traumatic injuries. Identification of a CML in a young child should prompt a thorough evaluation for physical abuse.

Keywords: Child abuse; Children; Classic metaphyseal lesion; Fractures; Radiography.

Publication types

  • Observational Study

MeSH terms

  • Bone and Bones / diagnostic imaging
  • Child Abuse / diagnosis*
  • Databases, Factual
  • Female
  • Fractures, Bone / diagnosis*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Prospective Studies
  • Radiography
  • Retrospective Studies
  • Soft Tissue Injuries / diagnosis*