Boaz Karmazyn MD, Presenter: Nothing to Disclose

Khaled Ali Ibrahim Hamada MD, Abstract Co-Author: Nothing to Disclose

Evaluate the incidence of metaphyseal fragmentation in the distal femur in children younger than 2 years who undergo skeletal survey for suspected child abuse.

From the radiology information system, we retrieved all reports (2003-2010) on skeletal survey for child abuse that included at least one of the following words: irregularity, step off, beak and spur. All of these studies were reviewed by a Pediatric Radiologist and a Pediatric Radiology Fellow. Patients with rickets and variation related to metaphyseal collar were excluded. Bone scans, if available, were also reviewed.  

1771 patients underwent skeletal survey. Nine (0.5%) patients (7 males) with age range of 2 -15 months had corner femoral metaphyseal fragmentation. The femoral fragmentation was unilateral in 7 patients and bilateral in 2 patients. The metaphyseal fragments were always found on the posteromedial corner of the distal femoral metaphysis. Six of the nine patients had other imaging of the femurs, including follow-up radiographs performed after 9 to 17 days (n=5), bone scans (n=3) and CT scans (n=2). There was no evidence of a fracture in any of these studies.  

Distal posteromedial femoral metaphyseal fragmentation is a rare variation in children younger than 15 months and can mimic classic metaphyseal lesion.

Posteromedial fragmentation in the distal femoral metaphysis can mimic classic metaphyseal lesion. Awareness of this rare variant is important to prevent false diagnosis of child abuse.

Karmazyn, B, Hamada, K, Posteromedial Metaphyseal Corner Fragmentation in the Femur: A Rare Variant That Can Mimic Classic Metaphyseal Lesion.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009719.html