Debate Over Unexplained Fractures Flares Anew

Several physicians have published in Pediatric Imaging (January 2014) “A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?” The article attacks the common belief among American physicians that certain kinds of apparent bone fractures in infants—called classic metaphyseal lesions, bucket-handle fractures, and corner fractures—occur almost exclusively as a result of physical child abuse.

The authors (David Ayoub, Charles Hyman, Marta Cohen, and Marvin Miller) find the evidence supporting this belief scant. They also say microscopic studies and x-rays of CMLs look similar to those of healing infantile rickets. They thus contend many injuries that most physicians would say show child abuse may instead show the child has had rickets or another metabolic disease. They “conclude that classic metaphyseal lesions are not true fractures.”

A commentary piece in the same issue of the same publication severely criticizes the article. It asserts that solid science shows CMLs to be products of child abuse.