Femoral shaft diaphysis tibial shaft diaphysis ankle distal tibial and fibula physeal. Metaphyseal corner fracture radiology reference article. The most subtle finding of an acute fracture is a radiolucent line extending laterally from the medial metaphyseal margin and is referred to as a metaphyseal lucency. Diaphyseal fractures are more common than metaphyseal fractures with inflicted trauma, but less specific. The term buckethandle fracture is used where the loose bone is rather wide at the distal end, making it end in a crescent shape. Note bucket handle appearance of distal metaphysis above. Skeletal imaging of child abuse nonaccidental injury. Fractures differentiating accidental trauma from child abuse.
Distinguishing child abuse fractures from rickets springerlink. The periphery of the fracture extends obliquely toward the diaphysis creating a triangular fragment corner fracture whereas the central portion of the fracture extends toward the physis resulting in a thin fragment bucket handle. All fractures of the femur in children should be referred to the orthopaedic team. Several studies have demonstrated that a short fall to the knee may produce a torus or impacted transverse fracture of the distal femoral metadiaphysis. Patient b has classic metaphyseal fractures of the distal left femur and proximal right tibia. Bucket handle fracture joseph junewick, md facr 02262009 history 9 month old female with multiple fractures.
A corner fracture or buckethandle fracture is fragmentation of the distal end of one or both femurs, with the loose piece appearing at the bone margins as an osseous density paralleling the metaphysis. However, as morisons term was used first, at the mayo clinic we always refer to such a fracture as a bucket handle. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. Both model and available experimental data substantiated this timedependent peak fracture load phenomenon for impact durations below 20 ms. Surgical therapy is focused on immediate fracture stabilisation offering a durable and solid fixation. A supracondylar femur fracture, also called a distal femur, is a break in the bone that occurs just above the knee joint. New bone formation leads to a thickened appearance and simulates the appearance of a handle. Metaphyseal corner fractures, also known as classical metaphyseal lesions cml or bucket handle fractures, are observed in young children, less than 2 years old. This injury is not only the fracture most specific for nai, it is also common among abused children, occurring in 50% range 3959%.
The ap view shows that the capitellum is displaced medially. The long, straight part of the femur thighbone is called the femoral shaft. Depending on how it is viewed, the fracture may appear as a corner injury or as a buckethandle fracture. Bucket handle medical definition merriamwebster medical. The indicated bucket handle fragment is more sharply defined than the healing zone of provisional calcification of fig. Their importance, however, lies in the significant morbidity and mortality associated with them, which is. These tools have been developed to assist in the implementation of the childhood fracture management project within your organisation. Femur fracture in child fracture in fractures metaphyseal corner bucket handle fractures posterior rib fxs digit fractures in nonambulatory children. Arthroscopy is used to diagnose and treat a wide range of knee problems. This is not a true bucket handle fracture, although it resembles a bucket handle. Metaphyseal corner fracture caused in utero by external cephalic version a rare presentation. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. Clinical report evaluating children with fractures for.
Any information contained in this pdf file is automatically generated from digital. While the head is the most common target for abuse, with. The pain may subside if the injured limb is protected. Rib fractures are very common and highly specific for abuse in young children less than 2 year. A further study confirmed classic metaphyseal lesions to be the most common fracture type, with. The bucket handle appearance, better seen using a beam with caudal angulation, is just an extension of this fracture line anterolaterally and may involve the tibial tubercle region. We present the unique case of a mcf of the distal femur caused. The classical metaphyseal corner or bucket handle fracture is virtually pathognomonic for abuse. This type of fracture is known in the orthopedic literature as a transepiphyseal transphyseal fracture. Pdf metaphyseal corner fractures mcfs in infants are strongly. Other injuries that are highly specific to child abuse are posterior rib fractures see the image below and fractures of the scapula, spinous process, and sternum, because these bones are ordinarily difficult to break. However, as morisons term was used first, at the mayo clinic we always refer to such a fracture as a buckethandle. When an unstable fragment from a buckethandle tear moves into the intracondlar. Most bucket handle fractures occur in the distal femur, proximal tibia, distal tibia, and proximal humerus.
Parallel increasing numbers of fatigue femur fractures are observed fol. Multiple fractures in infants who have ehlersdanloshypermobility. L, fractura, break a fracture of the wider end of a long bone along the growth plate forming an arc along the proximal margin. Pdf metaphyseal corner fracture caused in utero by. Distal femur thighbone fractures of the knee a fracture is a broken bone. Like the femur, the treatment of humerus fractures depends upon the fracture location and pattern. Corner or buckethandle fractures in children signs of. Child abuse fractures musculoskeletal medicine for. It is very important to note that there is no other sign of rickets. Fractures of femur requiring urgent orthopaedic referral. Other names for a corner fracture are a bucket handle fracture or metaphyseal fracture.
Fragility fractures of the proximal humerus commonly occur at the metaphysis, or surgical neck, of the humerus and are impacted and minimally displaced. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Corner fractures and bucket handle fractures are similar in etiology despite their different names. These fractures often involve the cartilage surface of the knee joint and are most commonly seen in people with severe osteoporosis or those who have previously undergone total knee replacement surgery. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Among younger children femur fractures raise the suspect of abuse. Spiral fracture of femur in a 3 month old which was the result of nai. Arrow was reported to highlight neonatal buckethandle fracture of distal femur after cesarean delivery. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. A followup view of this elbow is taken one month later. In 1918, without knowing of this description, i described the same type of lesion and called it a loop fracture.
Nonaccidental trauma nat in pediatric patients orthopaedic. Osteolytic or osteoblastic metastasis can lead to pain and immobilisation due to a pathologic femur fracture. Fracture classification two anatomy of the growth plate physis longitudinal bone growth of extremities by physis closure of physes growth plates by age and sex fat pad sign metaphyseal corner or bucket handle fracture salterharris classification of physeal fractures. Soft tissues superior to the midshaft of the femur and inferior to the mid. Transverse fracture with displacement and shortening.
The classic metaphyseal lesion is highly associated with abuse in infants. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent problem. The distal femur is where the bone flares out like an upsidedown funnel. A corner fracture refers to injury of the metaphysis, or the growing plate at either end of long bones, such as the femur and tibia. When an unstable fragment from a bucket handle tear moves into the intracondlar. Metaphyseal bucket handle or corner fractures result from pulling or twisting an extremity suddenly and forcibly. Biomechanical investigation of the classic metaphyseal. By definition, a buckle fracture is a stable fracture and stable fractures are less painful. In a study of 31 fatally abused infants with skeletal injuries, kleinman et al. Are bucket handle fractures the same as corner fractures.
Fractures of the mandible are common in patients, who sustain facial trauma. In fatally abused infants, classic metaphyseal lesions are the most common fracture. Anteroposterior radiograph of the left knee shows a bucket handle fracture fragment black arrows from child abuse in a 3monthold girl who also had a suspicious fracture of a humerus diaphysis. Fractures of the acromion, sternum and spinous processes are so rare in other conditions, that this affords them a high specificity for abuse.
Femur shaft fractures broken thighbone orthoinfo aaos. Corner fractures and buckethandle fractures have been. Upper extremity fractures generally occur with a fall onto an outstretched arm. Pdf metaphyseal corner fracture caused in utero by external. The metaphysis is a piece of cartilage in children, not yet a fully ossified bone. During knee arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your knee joint. Discussion the first case of nonaccidental trauma was described by john caffey in an infant with multiple fractures and bilateral subdural hematomas in 1946. Neurovascular injuries are mostly observed in the type 3 distal femur complex trauma.
Most mandibular fractures are seen to occur in male patients. In particular, bucket handle fractures classic metaphyseal lesions at. Knee arthroscopy is a surgical procedure that allows doctors to view the knee joint without making a large incision cut through the skin and other soft tissues. Another genesis of femur fractures is carcinogenic. Meniscus tears are among the most common knee injuries. Establishing signs for acute and healing phases of distal. Transverse fractures result from a direct impact to the bone.
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