{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:08:52Z","timestamp":1777896532801,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Leg J"],"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Background<\/jats:title>\n Distal femoral metaphyseal fractures in children pose diagnostic challenges due to potential accidental and non-accidental aetiologies. This review aims to critically analyse the evidence on the association between distal femoral metaphyseal fractures and child abuse, as well as fracture patterns aiding in distinguishing inflicted injuries from accidental injuries.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A systematic review of studies involving children with distal femoral metaphyseal fractures was conducted, examining the reported associations with child abuse, fracture patterns and proposed mechanisms.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The review revealed a significant association between distal femoral metaphyseal fractures and child abuse, particularly in non-ambulatory infants. However, some fractures may occur accidentally, often from short falls with direct impact on the knee. Certain fracture patterns, such as transverse or oblique configurations, suggest abuse, while spiral or buckle patterns are more likely accidental. Case series and retrospective studies reported varying findings, with some studies supporting a strong association with abuse and others highlighting the potential for accidental mechanisms.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A comprehensive evaluation, including history, physical examination, skeletal survey and multidisciplinary collaboration, is crucial for accurate diagnosis and management. Healthcare professionals should maintain a high index of suspicion for child abuse while recognising accidental mechanisms. Specific recommendations for healthcare professionals and future research directions are provided.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/00258172241293885","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T20:10:59Z","timestamp":1743106259000},"page":"137-142","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal femoral metaphyseal fractures in children: A systematic review and meta-analysis of their significance in the context of child abuse"],"prefix":"10.1177","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4720-3812","authenticated-orcid":false,"given":"Shrayash","family":"Khare","sequence":"first","affiliation":[{"name":"Weill Cornell Medicine, New York; New York City Health and Hospitals: Lincoln, New York."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181558b13"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1339-z"},{"issue":"1","key":"e_1_3_3_4_2","first-page":"1","article-title":"Characteristics of distal femoral metaphyseal fractures in child abuse: a systematic review and meta-analysis","volume":"15","author":"Chen W","year":"2020","unstructured":"Chen W, Shi J, Qian H, et\u00a0al. Characteristics of distal femoral metaphyseal fractures in child abuse: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15(1): 1\u201310.","journal-title":"J Orthop Surg Res"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3793"},{"key":"e_1_3_3_6_2","first-page":"3","volume-title":"Revista Espa\u00f1ola de Cirug\u00eda Ortop\u00e9dica y Traumatolog\u00eda (English Edition)","author":"Garcia-Mata S","year":"2017","unstructured":"Garcia-Mata S, Hidalgo-Ovejero A, Martinez-Grande M. Fracture patterns in non-accidental injuries in children. Revista Espa\u00f1ola de Cirug\u00eda Ortop\u00e9dica y Traumatolog\u00eda (English Edition) 2017; 61(1), 3\u20139."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181c330f0"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181653bf9"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.5733"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1518"},{"issue":"1","key":"e_1_3_3_11_2","first-page":"e20172209","article-title":"Fractures and traumatic brain injuries: abuse versus accidents in a US database of hospitalized children","volume":"142","author":"Leventhal JM","year":"2018","unstructured":"Leventhal JM, Martin KD, Asnes AG. Fractures and traumatic brain injuries: abuse versus accidents in a US database of hospitalized children. Pediatrics 2018; 142(1): e20172209.","journal-title":"Pediatrics"},{"issue":"3","key":"e_1_3_3_12_2","first-page":"e950","article-title":"Estimating the probability of abusive head trauma: a pooled analysis","volume":"131","author":"Maguire SA","year":"2013","unstructured":"Maguire SA, Kemp AM, Lumb RC, et\u00a0al. Estimating the probability of abusive head trauma: a pooled analysis. Pediatrics 2013; 131(3): e950\u2013e957.","journal-title":"Pediatrics"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181b2b3ee"},{"issue":"6","key":"e_1_3_3_14_2","first-page":"793","article-title":"Features of femoral fractures in nonaccidental injury","volume":"20","author":"Rex C","year":"2015","unstructured":"Rex C, Kay PR. Features of femoral fractures in nonaccidental injury. J Pediatr Orthop 2015; 20(6): 793\u2013797.","journal-title":"J Pediatr Orthop"},{"key":"e_1_3_3_15_2","first-page":"279","article-title":"Assessment of injury potential in pediatric accidental and abusive short falls using anthropomorphic test devices","volume":"125","author":"Thompson A","year":"2019","unstructured":"Thompson A, Bertocci G, Pierce MC. Assessment of injury potential in pediatric accidental and abusive short falls using anthropomorphic test devices. Accid Anal Prev 2019; 125: 279\u2013289.","journal-title":"Accid Anal Prev"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3242"}],"container-title":["Medico-Legal Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172241293885","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00258172241293885","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258172241293885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:29:39Z","timestamp":1777624179000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00258172241293885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1177\/00258172241293885"],"URL":"https:\/\/doi.org\/10.1177\/00258172241293885","relation":{},"ISSN":["0025-8172","2042-1834"],"issn-type":[{"value":"0025-8172","type":"print"},{"value":"2042-1834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}