A witnessed case of a classic metaphyseal fracture caused during IV line placement in a child: Insight into mechanism of injury.
Recent publications argue that classic metaphyseal fractures are caused by rickets as opposed to trauma. Previous case reports of accidental traumatic classic metaphyseal fractures have been discounted due to lack of identification of the fracture at the time of the traumatic event, and lack of an evaluation for boney metabolic disorders. We report a case of a 20 day old male with a diagnosis of congenital vertical talus who sustained a classic metaphyseal fracture of the distal tibia during manipulation in preparation for intravenous line placement. The mechanics of the event causing the classic metaphyseal fracture were witnessed and accompanied by an audible "pop". Prior x-rays of the tibia demonstrate normal osseous morphology, and an evaluation for boney metabolic disorders was normal. This case identifies a traumatic classic metaphyseal fracture and provides insight into the types of forces necessary to cause such a fracture.
Division of Child Abuse and Neglect, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA. Electronic address: tburrell@cmh.edu.
Tanya
T
Burrell
Department of Radiology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine Kansas City, MO 64108, USA. Electronic address: ekopfer@cmh.edu.
Erin
E
Opfer
Division of Orthopaedic Surgery, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine Kansas City, MO 64108, USA. Electronic address: lberglund@cmh.edu.
Lisa
L
Berglund
Department of Radiology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine Kansas City, MO 64108, USA. Electronic address: llowe@cmh.edu.
Lisa H
LH
Lowe
Division of Child Abuse and Neglect, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA. Electronic address: jdanderst@cmh.edu.
James
J
Anderst
D004838:Epiphyses / Q000293:injuries; D006801:Humans; D007049:Iatrogenic Disease; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000009:adverse effects*; D008297:Male; D013978:Tibial Fractures / Q000209:etiology*
Child abuse; Classic metaphyseal fracture; Rickets