Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures.

Abstract

We examined histologically 40 bones from 11 infants aged < 1 year who died with evidence of infant abuse. Twenty-three bones had fractures, and 15 of these contained conspicuous metaphyseal extensions of hypertrophied chondrocytes (EHC) which were highly associated with healing fracture sites. These data indicate that such lesions are common in fractures related to child abuse, are easily identified, and are indicative of healing fractures. The presence of this lesion has significant implications for those who assess skeletal injury in abused infants because the determination of infant abuse often relies on establishing a pattern of skeletal trauma. Quantitation of the growth rate of individual physes in this age group may eventually permit assessment of the minimum age of these skeletal injuries.