Injuries: child physical abuse, fractures: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries: child physical abuse, fractures

Sample item

A 4-month-old infant is irritable with swelling of the right thigh. The history from the parents is vague. A skeletal survey shows corner (bucket-handle) fractures of the distal femoral metaphysis. Which statement is most accurate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Classic metaphyseal lesions are highly specific for abuse, caused by shearing forces from pulling or twisting the limb

Classic metaphyseal lesions (corner or bucket-handle fractures) result from shearing forces across the growth plate when a limb is jerked, pulled or twisted. They are highly specific for non-accidental injury in infants, as are posterior rib fractures. A discrepant history in a non-ambulant infant should prompt a child protection assessment.

Option by option

  • A. They are a common result of normal handling during nappy changes

    Normal handling does not generate enough shearing force to fracture the growth plate.

  • B. They show that the infant has rickets

    Rickets produces cupping and fraying of metaphyses, not corner fractures after injury.

  • C. Classic metaphyseal lesions are highly specific for abuse, caused by shearing forces from pulling or twisting the limb (correct)

    Correct. These shear fractures are highly specific for abusive injury in infants.

  • D. They are typical of a fall from the parent's arms onto a carpet

    A short fall onto a soft surface rarely fractures infant bone and does not explain a metaphyseal corner lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Classic metaphyseal lesions are highly specific for abuse, caused by shearing forces from pulling or twisting the limb. Classic metaphyseal lesions (corner or bucket-handle fractures) result from shearing forces across the growth plate when a limb is jerked, pulled or twisted.

Why is "They are a common result of normal handling during nappy changes" not the answer?

Normal handling does not generate enough shearing force to fracture the growth plate.

Why is "They show that the infant has rickets" not the answer?

Rickets produces cupping and fraying of metaphyses, not corner fractures after injury.

Why is "They are typical of a fall from the parent's arms onto a carpet" not the answer?

A short fall onto a soft surface rarely fractures infant bone and does not explain a metaphyseal corner lesion.

What concept does this question test?

It tests Injuries: child physical abuse, fractures in Forensic Medicine. They are highly specific for non-accidental injury in infants, as are posterior rib fractures. A discrepant history in a non-ambulant infant should prompt a child protection assessment.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries: child physical abuse, fractures?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.