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Metaphyseal fractures are nasty bone breaks which almost always trigger an accusation of non-accidental injury (NAI). This article is the second in my series on NAI posts. You can find the first one about being accused of NAI here.
In today’s post, I talk about what metaphyseal fractures are and why people link them to abuse. But most importantly discuss how metaphyseal fractures occur by accident and how they’re linked to hypermobility and autism.
What is a classic metaphyseal fracture?
Metaphyseal fractures have several different names, including corner fractures, bucket handle fractures and metaphyseal lesions. These type of fractures happen at the growth plate in infants.
Where is a metaphyseal fracture located?
Metaphyseal fractures occur at the growth plates, they’re located at the end of long bones. The bones often affected are the tibia, fibula, radius, and ulna.
Are metaphyseal fractures a sign of abuse?
Yes. It’s well-documented that metaphyseal fractures are a sign of childhood abuse. This is because this type of fracture is believed to be caused by a twist and pull to the infant’s bones – something which can’t be done accidentally.
However, research is slowly revealing that other metaphyseal fractures can and do occur from other causes.
For example, a 2020 piece of research called ‘Are classic metaphyseal lesions pathognomonic for child abuse? Two cases of motor vehicle collision-related extremity CML and a review of the literature’ reported on two cases where two children experienced metaphyseal fractures as a result of being in motor vehicle collisions. Therefore, demonstrating that a forceful twist or pull is not needed to cause such a fracture.
What causes metaphyseal fractures?
As mentioned above a twist and/or pull is generally considered as the cause of metaphyseal fractures. They can also be caused by shaking the child making their limbs move quickly from side to side. Significant force is believed to be involved but the exact force needed is unknown.
But just because science says that this is how a metaphyseal fracture occurs doesn’t mean that something else can’t be the cause.
Some real-life examples of metaphyseal fractures include:
- Pushing a child over in a roll
- Bicycle kicks
- The child’s arm getting caught in their car seat straps
- A child’s limb getting caught in between cot bars
Now, because the findings made in family courts are kept top secret (aside from a rare few cases), you’re unlikely to find examples online of infants getting metaphyseal fractures for these reasons. However, parents who’ve been accused of causing an NAI talk. They share their theories and suggestions made in court by experts, and these are all genuine causes of this type of fracture.
Let’s take a look at pushing a child over in a roll in more detail. A 2020 study concluded that an external force (force was not determined but was not deemed substantial) can lead to an oblique spiral fracture of the humeral diaphysis in non-mobile babies.
One example was caught on video. The infant was laying stomach down (prone position) and its arm was extended away from its body. The baby’s older sibling rolled the baby over so that the baby was laying on its back (supine position). As this roll occurred, the film picked up the sound of the fracture as it happened.
Although this was not a metaphyseal fracture, it can be argued that it’s possible the same action could cause a metaphyseal fracture. The reason for this is that:
- Metaphyseal fractures are typically caused by a lesser force than spiral fractures.
- Spiral fractures are caused by a strong twist to the bone which is similar to how metaphyseal fractures are thought to occur.
When is a metaphyseal fracture not a metaphyseal fracture?
You may find it hard to believe but doctors get it wrong – a lot! This is especially the case with EDS and hypermobility, because they’re rare conditions that are not properly understood in the general medical world.
They won’t like me saying this, but there are also some doctors, radiologists, paediatricians, etc that are not very good. And, unfortunately, this can result in a misdiagnosis.
I’ve read examples of cases where parents have been told that they’re children have got multiple fractures, including metaphyseal fractures throughout their bodies. In some cases, this is just one or two, it’s in the tens! Once the case went to court and experts got involved, these ‘fractures’ weren’t fractures at all. Instead, they were normal growing bones!
This is absolutely shocking and goes to show that one person’s view should not be considered enough to remove children from their parents and start legal proceedings against them.
Autism and metaphyseal fractures
One thing to consider when a child gets a metaphyseal fracture and you’re accused of causing it is whether your child may have autism spectrum disorder (ASD). Now, I understand that this isn’t a natural link, but it’s something worth considering, particularly if your child is male.
The study Bone Health in Boys with Autism Spectrum Disorder found that boys with autism have significantly lower trabecular bone mineral density and bone strength at the radius. The radius, along with the ulna, makes up the forearm.
Therefore, if your child is diagnosed with a distal radius metaphyseal fracture, carefully think about whether your child may have autism. Because if they do, it could have resulted in significantly lower bone mass and be the reason for your child’s metaphyseal fracture.
Related Post: Explore the link between hypermobility & autism
The problem with this is that it takes a long time for autism to be diagnosed. Typically, the earliest it can be picked up is 18 months of age. So, if you have a young infant with a metaphyseal fracture, it may be difficult to get people to listen to you if you suspect that autism is the cause of your child’s fracture.
Things that will go in your favour at this point include:
- Having older children with autism. There’s a 1 in 5 chance that subsequent children will also have autism.
- Your child having an aunt or uncle with autism. Research says that this increases the likelihood of a child being diagnosed with ASD by up to 230%.
- Having ASD in your child’s family – ASD is heredity. So, having any family member with ASD increases the chances of your child having it.
Hypermobility and metaphyseal fractures
We’re a hypermobility site so of course we can’t leave out the link between hypermobility and metaphyseal fractures.
The truth is no one knows how the two are connected. But there sure is a link. I’ve come across a flurry of parents whose children have been diagnosed with EDS/hEDS/HSD. Their children were diagnosed during court proceedings as a result of their child having one (or more) fractures. In most cases, no findings were made against the parents.
Now, this tells me that hypermobility is linked to fractures and that experts and courts accept this connection. It’s just a shame that no one will come out publicly and say this. After all, if they did, they’d save lots of parents and children a whole lot of heartache.
Here’s some literature to back up the hypermobility and fracture link:
- Higher fracture prevalence and smaller bone size in patients with hEDS/HSD—a prospective cohort study
- Multiple fractures in infants who have Ehlers-Danlos/hypermobility syndrome and or vitamin D deficiency
- Hypothesis: Hypermobile Ehlers Danlos Syndrome Is a Determinant of Fetal and Young Infant Bone Strength
I mentioned above about autism causing fractures. It’s also important to note that up to 80% of people with autism have hypermobility. In theory, the fracture risk could be increased further if both conditions are present.