Problems in the diagnosis of metaphyseal fractures

Abstract

The radiographic projection influences the appearance of the metaphyseal fragment. If the long axis of the metaphysis and the radiographic projection are at right angles, the thicker peripheral margin of the metaphyseal fragment will be viewed end-on as a relatively discrete triangular bony fragment. A caudally or cranially angulated radiographic projection results in a curvilinear bony density that represents the dense peripheral margin of the fracture fragment that has been separated from the metaphysis. Thus, in one projection a fragment may appear as a corner fracture, and in another view, as a bucket-handle lesion. From autopsy and clinical studies it is evident that bruising overlying CMLs is often absent. (orig.)