title: Absence of rickets in infants with fatal abusive head trauma and classic metaphyseal lesions.
abstract: OBJECTIVE
  To determine if rickets is present in cases of infant homicide with classic metaphyseal lesions (CMLs) and other skeletal injuries.
  
  
  METHODS
  This study was exempt from the institutional human subjects board review because all infants were deceased. An archival review (1984-2012) was performed of the radiologic and histopathologic findings of 46 consecutive infant fatalities referred from the state medical examiner's office for the evaluation of possible child abuse. Thirty infants with distal femoral histologic material were identified. Additional inclusion criteria were as follows: (a) The medical examiner determined that the infant had sustained a head injury and that the manner of death was a homicide, (b) at least one CML was evident at skeletal survey, (c) CMLs were confirmed at autopsy, and (d) non-CML fractures were also present. Nine infants (mean age, 3.9 months; age range, 1-9 months) were identified. Two pediatric radiologists independently reviewed the skeletal surveys for rachitic changes at the wrists and knees. A bone and soft tissue pathologist reviewed the distal femoral histologic slices for rickets.
  
  
  RESULTS
  There were no radiographic or pathologic features of rickets in the cohort.
  
  
  CONCLUSIONS
  The findings provide no support for the view that the CML is due to rickets. Rather, they strengthen a robust literature that states that the CML is a traumatic injury commonly encountered in physically abused infants.
authors: From the Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (J.M.P., A.T., P.K.K.); Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC (A.G.M.); and Department of Pathology, University of Miami Hospital, Miami, Fla (A.E.R.).
authors: Jeannette M
authors: JM
authors: Perez-Rossello
authors: Anna G
authors: AG
authors: McDonald
authors: Andrew E
authors: AE
authors: Rosenberg
authors: Andy
authors: A
authors: Tsai
authors: Paul K
authors: PK
authors: Kleinman
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000401:mortality*; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005269:Femur; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012279:Rickets / Q000175:diagnosis*