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