title: Can classic metaphyseal lesions follow uncomplicated caesarean section?
abstract: BACKGROUND
  Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury.
  
  
  OBJECTIVE
  To demonstrate that the CML may occur following simple lower segment caesarean section (LSCS).
  
  
  METHODS
  A review of 22 years of an obstetric practice that delivers 8,500 babies per year.
  
  
  RESULTS
  We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML.
  
  
  CONCLUSIONS
  We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed.
authors: Radiology Department, Children's University Hospital, Temple Street, Dublin 1, Ireland. amoconnell@yahoo.com
authors: Annamarie
authors: A
authors: O'Connell
authors: Veronica B
authors: VB
authors: Donoghue
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D003937:Diagnosis, Differential; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000175:diagnosis* / Q000209:etiology*; D005269:Femur / Q000000981:diagnostic imaging / Q000293:injuries*; D017102:Fracture Healing; D006801:Humans; D007231:Infant, Newborn; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011859:Radiography; D014102:Torsion Abnormality