Peidatrics Case 7 Background

Metaphyseal Corner Fracture

Distal femoral physis fractures account for approximately 5% of all physeal fractures. Metaphyseal corner fractures (or bucket-handle fractures) are classified as Type II Salter-Harris fractures.

While metaphyseal corner fractures can occur in both accidental and non-accidental trauma, it is very unlikely that these fractures occur in healthy bones secondary to accidental trauma (although they can occur with birth trauma). When the bone appears abnormal (demineralized, osteoporotic, etc), the fracture is most likely pathologic secondary to an underlying disease process.

In children with normal bones that present with a metaphyseal corner fracture, clinicians should be highly suspicious of non-accidental trauma. Fractures secondary to abuse occur mostly in infants and toddlers, who seldom generate enough force to cause femur fractures unless abused.