ArticlePediatric radiology2017
Biomechanics of the classic metaphyseal lesion: finite element analysis.
Article in Pediatric radiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Revisiting the radiographic assessment of osteoporosis-Osteopenia in children 0-2 years of age. A systematic review.PloS one · 2020Pooled it
- Data-driven standards for infant skull thickness distributions in computational modeling and analysis.Journal of anatomy · 2025Article
- Post-mortem skeletal survey (PMSS) versus post-mortem computed tomography (PMCT) for the detection of corner metaphyseal lesions (CML) in children.European radiology · 2024Article
- Comparison of different internal fixation models in ankle arthrodesis using 3D finite-element analysis.European journal of medical research · 2023Article
- Fractures of child abuse.Pediatric radiology · 2021Review
- Buckle fracture of the proximal tibia in children and frequency of association with trampoline and inflatable bouncer use.Pediatric radiology · 2019Article
- Prevalence of metaphyseal injury and its mimickers in otherwise healthy children under two years of age.Pediatric radiology · 2019Article
- Ultrasound findings in classic metaphyseal lesions: emphasis on the metaphyseal bone collar and zone of provisional calcification.Pediatric radiology · 2019Article
- Finite element modelling of the developing infant femur using paired CT and MRI scans.PloS one · 2019Article
- The distal tibial classic metaphyseal lesion: medial versus lateral cortical injury.Pediatric radiology · 2018Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe classic metaphyseal lesion (CML) is strongly associated with infant abuse, but the biomechanics responsible for this injury have not been rigorously studied. Radiologic and CT-pathological correlates show that the distal tibial CML always involves the cortex near the subperiosteal bone collar, with variable extension of the fracture into the medullary cavity. Therefore, it is reasonable to assume that the primary site of bone failure is cortical, rather than intramedullary.
objectiveThis study focuses on the strain patterns generated from finite element modeling to identify loading scenarios and regions of the cortex that are susceptible to bone failure. MATERIALS AND
methodsA geometric model was constructed from a normal 3-month-old infant's distal tibia and fibula. The model's boundary conditions were set to mimic forceful manipulation of the ankle with eight load modalities (tension, compression, internal rotation, external rotation, dorsiflexion, plantar flexion, valgus bending and varus bending).
resultsFor all modalities except internal and external rotation, simulations showed increased cortical strains near the subperiosteal bone collar. Tension generated the largest magnitude of cortical strain (24%) that was uniformly distributed near the subperiosteal bone collar. Compression generated the same distribution of strain but to a lesser magnitude overall (15%). Dorsiflexion and plantar flexion generated high (22%) and moderate (14%) localized cortical strains, respectively, near the subperiosteal bone collar. Lower cortical strains resulted from valgus bending, varus bending, internal rotation and external rotation (8-10%). The highest valgus and varus bending cortical strains occurred medially.
conclusionThese simulations suggest that the likelihood of the initial cortical bone failure of the CML is higher along the margin of the subperiosteal bone collar when the ankle is under tension, compression, valgus bending, varus bending, dorsiflexion and plantar flexion, but not under internal and external rotation. Focal cortical strains along the medial margins of the subperiosteal bone collar with varus and valgus bending may explain the known tendency for focal distal tibial CMLs to occur medially. Further research is needed to determine the threshold of applied forces required to produce this strong indicator of infant abuse.
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