Audrey Hepburn CARE Center, Children's Hospital of New Orleans, New Orleans, LA, USA.
Le Bonheur CARES Team, The University of Tennessee Health Science Center, Memphis, TN, USA.
J Forensic Leg Med. 2020 Aug;74:102006. doi: 10.1016/j.jflm.2020.102006. Epub 2020 Jun 30.
Long bone fractures at the infant growth plate, known as classic metaphyseal lesions (CMLs), raise a strong suspicion for abusive injury. CMLs persist as a hallmark for inflicted injury although a handful of documented cases of CMLs created by other, non-abusive mechanisms within various healthcare settings are scattered throughout the past few decades of medical literature. The forces required to sustain a CML are typically defined as a combination of tensile, compressive, or rotational energy applied to the metaphyseal regions of an infant's long bones. Recently, two separate child protection teams each encountered a case of CML discovered after reported motor vehicle collisions (MVC). This provoked a critical appraisal of the medical literature to inform clinical practice regarding MVCs as a potential mechanism for this fracture type and to remind clinicians that there is no single injury pathognomonic for abuse.
婴儿生长板处的长骨骨折，即经典干骺端病变（CMLs），强烈提示为虐待性损伤。尽管过去几十年的医学文献中有少数几例由其他非虐待性机制引起的 CML 病例，但 CML 仍然是虐待性损伤的标志。维持 CML 所需的力通常被定义为施加在婴儿长骨干骺端区域的拉伸、压缩或旋转能量的组合。最近，两个独立的儿童保护小组都遇到了一起在报告的机动车碰撞（MVC）后发现的 CML 病例。这促使对医学文献进行了批判性评估，以便就 MVC 作为这种骨折类型的潜在机制为临床实践提供信息，并提醒临床医生，没有一种单一的损伤特征可以明确提示虐待行为。
