Long Bone, Metaphyseal Fraying
Cheryl A. Petersilge, MD
DIFFERENTIAL DIAGNOSIS
Common
Chronic Repetitive Trauma
Osteomyelitis, Pediatric
Physeal Fractures, Pediatric
Child Abuse, Metaphyseal Fracture
Less Common
Rickets
Thermal Injury
Neuropathic Disease
Rare but Important
Radiation
Hypophosphatasia
Copper Deficiency, Infantile
Metaphyseal Chondrodysplasias
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Hint: Differentiate isolated/multisite from systemic involvement
Systemic: Sites of rapid growth = proximal and distal tibia/fibula, distal radius/ulna
Isolated/multisite: Chronic repetitive trauma, osteomyelitis, fracture, thermal injury, neuropathic disease, radiation
Metaphyseal sclerosis common
Periosteal new bone with fractures, trauma, osteomyelitis, neuropathic disease
Helpful Clues for Common Diagnoses
Chronic Repetitive Trauma
Sport/situation and site specific
Osteomyelitis, Pediatric
Focal metaphyseal osteopenia and destruction
Physeal Fractures, Pediatric
Any healing fracture or avulsion
Child Abuse, Metaphyseal Fracture
Corner fractures, cupping late
Helpful Clues for Less Common Diagnoses
Rickets
Metaphyseal osteolysis & cupping, coarse ill-defined trabecula, rachitic rosary, enlarged knees, ankles, & wrists
Generalized osteopenia, delayed skeletal maturation, bowing
Thermal Injury
Soft tissues changes, including calcification
Neuropathic Disease
Exaggerated changes, including extensive fragmentation
Helpful Clues for Rare Diagnoses
Radiation
Regional osteopenia
Hypophosphatasia
Hint: Distinct finger-like lucent extension into metaphysis from growth plate
Osteopenia, cranial synostosis, bowing, fractures, metaphyseal spurs
Copper Deficiency, Infantile
Metaphyseal cupping and spurs, hypotonia, seizures, mental retardation
Metaphyseal Chondrodysplasia
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