title: The classic metaphyseal lesion and traumatic injury.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Child and Family Advocacy, Nationwide Children's Hospital, 655 E. Livingston Ave., Columbus, OH, 43205, USA. jonathan.thackeray@nationwidechildrens.org.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Thackeray
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Wannemacher
authors.affiliation: Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Brent H
authors.initials: BH
authors.lastname: Adler
authors.affiliation: Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lindberg
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging; D002649:Child Abuse / Q000175:diagnosis*; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis*
keywords: Child abuse; Children; Classic metaphyseal lesion; Fractures; Radiography