RELATIONSHIP OF THE SUBPERIOSTEAL BONE COLLAR TO METAPHYSEAL LESIONS IN ABUSED INFANTS

We studied the relationship between the subperiosteal bone collar and forty metaphyseal lesions in specimens obtained at autopsy from ten in fants who died with evidence of abuse. The fracture specimens were stu died with high-detail radiography and light microscopy, The typical mo rphological pattern was a fracture extending through the primary spong iosa adjacent to the chondro-osseous junction. As the fracture line ap proached the cortex, it veered away from the growth plate, undercuttin g a fragment of bone that was thicker peripherally than it was central ly. Histological examination showed that this peripheral fragment of b one included the subperiosteal bone collar. Inclusion of the subperios teal bone collar within the peripheral portion of the metaphyseal frac ture fragment explains the radiographic appearance of corner fractures and bucket-handle patterns described by Caffey in abused infants.