ABSTRACT
Classical metaphyseal lesions (CMLs) are seen in infants at the ends of the long bones, immediately adjacent to the growth plate. Histologically, a thin transverse plate of bone is detached from the adjacent metaphysis. Radiologically, this is seen as a circumferential rim because of the relatively thicker metaphyseal ‘cuff’, rather than as a plate of bone. CMLs are thought to result from the direct application, simultaneously, of gripping, twisting and pulling forces at the sites of the fractures. It has also been suggested that CMLs may occur during the course of a shaking episode. In this situation the limbs flail about and during this process may generate the appropriately severe tractional and torsional forces. CMLs may or may not be associated with periosteal new bone formation as part of the healing process. Typically the healing process is radiologically complete in four weeks.
