Advertisement

Pediatric Radiology

, Volume 49, Issue 13, pp 1840–1842 | Cite as

Classic metaphyseal lesion of distal tibia following footling breech delivery

  • Gloria S. LeeEmail author
  • Sosamma T. Methratta
  • Lori D. Frasier
Case Report

Abstract

Classic metaphyseal lesions associated with childbirth are rare. We report a distal tibial metaphyseal fracture following a difficult breech delivery. Classic metaphyseal fractures are considered highly specific injuries associated with non-accidental trauma. This case depicts a classic metaphyseal lesion sustained during footling breech extraction in an urgent delivery. The traction and torque placed on the distal extremities during this difficult delivery suggest a potential mechanism for this injury.

Keywords

Birth injury Breech delivery Child abuse Classic metaphyseal lesion Footling presentation Neonate Tibial fracture 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Kleinman PK, Marks SC Jr (1996) A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. AJR Am J Roentgenol 166:1207–1212CrossRefGoogle Scholar
  2. 2.
    Kleinman PK (2008) Problems in the diagnosis of metaphyseal fractures. Pediatr Radiol 38:S388–S394CrossRefGoogle Scholar
  3. 3.
    O'Connell A, Donoghue VB (2007) Can classic metaphyseal lesions follow uncomplicated caesarean section? Pediatr Radiol 37:488–491CrossRefGoogle Scholar
  4. 4.
    Lysack JT, Soboleski D (2003) Classic metaphyseal lesion following external cephalic version and cesarean section. Pediatr Radiol 33:422–424CrossRefGoogle Scholar
  5. 5.
    Morris S, Cassidy N, Stephens M et al (2002) Birth-associated femoral fractures: incidence and outcome. J Pediatr Orthop 22:27–30PubMedGoogle Scholar
  6. 6.
    Kleinman PK, Marks SC Jr (1995) Relationship of the subperiosteal bone collar to metaphyseal lesions in abused infants. J Bone Joint Surg Am 77:1471–1476CrossRefGoogle Scholar
  7. 7.
    Grayev AM, Boal DK, Wallach DM, Segal LS (2001) Metaphyseal fractures mimicking abuse during treatment for clubfoot. Pediatr Radiol 31:559–563CrossRefGoogle Scholar
  8. 8.
    Della Grotta LM, Marine MB, Harris TL, Karmazyn B (2019) Classic metaphyseal lesion acquired during physical therapy. Clin Imaging 54:100–102CrossRefGoogle Scholar
  9. 9.
    Burrell T, Opfer E, Berglund L et al (2015) A witnessed case of a classic metaphyseal fracture caused during IV line placement in a child: insight into mechanism of injury. J Forensic Leg Med 35:51–53CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Center for the Protection of Children, Penn State Health Children’s HospitalPenn State College of MedicineHersheyUSA
  2. 2.Division of Pediatric Radiology, Penn State Health Children’s HospitalPenn State College of MedicineHersheyUSA
  3. 3.Center for the Protection of Children, Penn State Health Children’s HospitalPenn State College of MedicineHersheyUSA

Personalised recommendations