Bryan Zuniga, Nicholas Lopez, Kirsten Simonton, Jonathan D Samet
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引用次数: 0
Abstract
Background: Skeletal abnormalities are important to recognize in the workup of physical child abuse. Normal variants can simulate child abuse and cause incorrect diagnosis and management. An osseous protuberance of the proximal medial tibial metaphysis, "the tibial bump," is a normal variant that is important to recognize.
Objective: To determine the prevalence of a tibial bump in infants undergoing a skeletal survey for a child abuse evaluation.
Materials and methods: A retrospective study of initial and follow-up child abuse skeletal surveys at a tertiary center was conducted to assess for the presence of a tibial bump on the proximal medial tibial metaphysis. The presence or absence of fracture healing changes around the tibial bump was recorded.
Results: Twenty of two hundred sixty cases showed a tibial bump on the initial skeletal survey, estimating a prevalence of 7.7%. Fourteen of these twenty cases (70%) demonstrated a persistent tibial bump unchanged in appearance on the follow-up skeletal survey. None of the tibial bumps demonstrated findings of a healing fracture on the initial or follow-up skeletal survey. In cases with a tibial bump present, 10 (50%) were bilateral and 10 were unilateral (50%). The mean (median) age of a child with a tibial bump was 3.5 (2.9) months with a range from 1 to 8 months, and there was a statistically significant association between age and the presence of a bump, supporting that this is a finding of infancy (P = 0.04).
Conclusion: A tibial bump on the proximal medial tibial metaphysis was a relatively common finding in infants undergoing workup for child abuse and not radiographically consistent with a fracture. It is a normal variant and should not be confused with a traumatic finding.
期刊介绍：
Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology
Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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